€¦ · Web viewDUTIES: Light word processing, copying, filing. Activity Never Rare. 0-25% Occasional. 26-50% Frequent. 51-75% Constant. 76-100% Weight/Distance

Workers’ Compensation Services ● Risk Control ● 800.313.5888 ● coverys.com/rc

Organization NameSample Description of Temporary Transitional Task: Assistance with Inventory (BIOM-01)

Bio-Med Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech Date: ________

Temporary Transitional Task Supervisor: Administrative Asst.Shift: 7AM-3:30PM Length of Shift: 8 Max. 4 Min. Hours per Wk: 40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions. Knowledge of electronic parts. Read level numbers.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: X Odors: X Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Parts room PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _______________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Taking inventory of parts (repair parts for medical equipment).

Activity Never Rare0-25%

Occasional26-50%

Frequent51-75%

Constant76-100%

Weight/Distance/Height/Frequency

Activity Description

Standing X Can accommodateWalking XSitting X Can accommodateDriving X Travel to opposite campus.Lifting (light) 10-20 lbs.

X

Lifting(medium) 21-50 lbs.

X

Lifting (heavy) 51-100 lbs.

X

Carrying X <10 lbs. Can accommodatePush/Pull X May require use of cartReaching X To reach into binTwisting/Turning XBending X To reach partsStoop/Squat XKneeling X Can accommodateCrawling XClimbing X Step stool Can accommodateHand Movement XUpper Extremity XUses Foot Controls X Step stoolRepetition XBalancing X

Supervisor Signature: _______________________________________ Date: _____________________

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Organization NameSample Description of Temporary Transitional Task: Office Support (BIOM-02)

Bio-Med Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date: _____ Temporary Transitional Task Supervisor: Administrative Asst.

Shift: 7-3:30PM. Length of Shift: _2_ Max. 1 Min. Hours per Wk: Up to 10hrs/wkEDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...basic computer skills.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Shop area, message center

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES:copying, filing, answering telephone, typing, sorting


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Can accommodateWalking X Approx. 100 feet To go to copy machineSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <2 lbs. Files, paperworkPush/Pull XReaching X File cabinetsTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Survey Equipment (CPS-01)

Clinical Processing Service Department

Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Supervisor Clinical Processing Service

Shift: Start 6AM-9AM-End 2:30P-5: 30P;Start 2:30P-11P, 5:30P-2A. Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Ability to understand simple oral or written instruction.

SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception ___ Peripheral Vision___ Color Discrimination___ Hearing _X_

BRIEF DESCRIPTION: Surveying equipment

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: _X-hand washing_____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Patient rooms, entire hospital, clipboard and writing utensil. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__exam_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Tracking equipment on floor in patient rooms and utility rooms, writes and verifies findings against list, returning equipment.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-5 min Waiting on elevator, checkingWalking X 30-45 min at a time Walk to patient rooms and utility roomsSitting X 30-45 min at a time When writing results in log bookDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <10# Carrying clipboard, equipmentPush/Pull X <10# To obtain equipment (light)Reaching X 12” or less To obtain equipmentTwisting/Turning XBending XStoop/Squat X 10 times or less To obtain equipment, could accommodateKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Needs one hand, to write and obtain equipmentUpper Extremity X 30-45 min at a time Needs one arm to write and obtain equipmentUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (CPS-02)


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Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: Supervisor Clinical Processing ServiceShift: Start 6A-9A, End 2:30P-5: 30P; Start 2:30P, End 11P; 5:30P-2A;Start 11P to 7A. Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40


SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing X

BRIEF DESCRIPTION: Assisting at central processing service dispatch area.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: x-hand washing______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Central processing service dispatch area, phone, computer, office supplies PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs X Glasses/Goggles/Face Shield___ Head_X__ Shoe_X__DUTIES: Answer phone, taking messages, entering information into the computer, typing if able.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min at a time Obtain suppliesWalking X 1-3 min at a time Obtain suppliesSitting X 3-45 min at a time Sitting at a desk, sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying suppliesPush/Pull XReaching X 12 inches To obtain suppliesTwisting/Turning XBending X 6-12 inches from

floorTo obtain supplies

Stoop/Squat X 6-12 inches from floor

To obtain supplies

Kneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Needs one hand to perform clerical dutiesUpper Extremity X 30-45 min at a time Needs one arm to perform clerical dutiesUses Foot Controls XRepetition X 30-45 min at a time Inputting into computerBalancing X

Organization NameSample Description of Temporary Transitional Task: Prepare Peel Pouches (CPS-03)



COPYRIGHTED 4


Task Qualifications/Requirements/Training Category: Service Date: ________

Temporary Transitional Task Supervisor: Supervisor Clinical Processing Service

Shift: Start, 6AM-9AM,End 2:30-5:30; Start 2:30PM-End 11PM; 5:30PM-2AM, Start 11PM to 7AM. Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40


SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _X_

BRIEF DESCRIPTION: Assembling pouches.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: _X-hand washing_____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Clinical processing service

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs_X__ Glasses/Goggles/Face Shield___ Head__X_ Shoe__X_

DUTIES: Place instruments or supplies in ouch, seal and label.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min at a time Has sit or stand optionWalking X < 5 min daily Walking to work areaSitting X 30-45 min at a time Has sit or stand optionDriving XLifting (light) 10-20 lbs.

X Lifting supplies under 5 lbs


X


X

Carrying X < 5# Carrying supplies Push/Pull XReaching X 12 inches Reaching across the table to obtain suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Preparing packsUpper Extremity X 30-45 min at a time Preparing packsUses Foot Controls X 30-45 min at a time Foot control sealingRepetition X 30-45 min at a time Preparing packs.Balancing X


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Organization NameSample Description of Temporary Transitional Task: Preparing Autoclave Trays & Basins (CPS-04)



Temporary Transitional Task Supervisor: Supervisor Clinical Processing Service

Shift: Start, 6AM-9AM,End 2:30-5:30; Start 2:30PM-End 11PM; 5:30PM-2AM, Start 11PM to 7AM. Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40


SENSORY EFFECT/COMMUNICATION:Speech _ _ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _ _

BRIEF DESCRIPTION: Preparing autoclave trays and basins.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: _X-hand washing_____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Clinical processing service

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs _X_ Glasses/Goggles/Face Shield___ Head _X_ Shoe _X_

DUTIES: Replacing filter paper, labels, drying trays and basins.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min at a time Has sit or stand optionWalking X < 5 min daily Walking to work areaSitting X 30-45 min at a time Has sit or stand optionDriving XLifting (light) 10-20 lbs.

X Lifting supplies under 5 lbs


X


X

Carrying X < 5# Carrying supplies Push/Pull XReaching X 12 inches Reaching across the table to obtain suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Preparing packsUpper Extremity X 30-45 min at a time Preparing packsUses Foot Controls X 30-45 min at a time Foot control sealingRepetition X 30-45 min at a time Preparing packs.Balancing X

Organization Name


COPYRIGHTED 6


Sample Description of Temporary Transitional Task: Sorting Documents (COC-01)Continuum of Care Department

Task Qualifications/Requirements/Training Category: Tech/Prof/Service Date: ______ Temporary Transitional Task Supervisor: Director Continuum of CareShift: 7:00A-8: 00A. Length of Shift: 1 Max. 1 Min. Hours per Wk: Up to 5 hrs/wk

EDUCATION/EXPERIENCE: Ability to understand simple oral and written instruction…alphabetizing

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Sorting documents.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Continuum of Care office


DUTIES: Sorting UR sheets, admission discharge and transfer records.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <1 min To obtain suppliesWalking X 2 min To work areaSitting X 30-45 min at a time To sort documentsDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching X < 12 inches To obtain documentsTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Sorting documentsUpper Extremity X 30-45 min at a time Sorting documentsUses Foot Controls XRepetition X 30-45 min at a time Sorting documentsBalancing X


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Organization NameSample Description of Temporary Transitional Task: Reviewing Charts and Completing Forms (COC-02)

Continuum of Care Department

Task Qualifications/Requirements/Training Category: Tech/Prof Date: ________Temporary Transitional Task Supervisor: Director Continuum of CareShift: 7A-3:30P, 8A-5P. Length of Shift: 8 Max. 2 Min. Hours per Wk: up to 40 hrs/wk

EDUCATION/EXPERIENCE: RN, LPN, Social Worker

SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _X_ (can accommodate speech and hearing)

BRIEF DESCRIPTION: Reviewing charts and completing forms.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Continuum of Care office or medical records, or nursing units, telephone, fax machine


DUTIES: Reviewing chart, completing forms, calling insurance company.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-5 min At elevator obtain, could accommodateWalking X 2-3 min at a time To get to work areaSitting X 30-45 min at a time Review charts and complete forms sit/stand

optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying charts and suppliesPush/Pull XReaching 12” or less Obtain charts/no overheadTwisting/Turning XBending X 1-10 times To obtain record, could accommodateStoop/Squat X 1-10 times To obtain record, could accommodateKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Review chart and complete formsUpper Extremity X 30-45 min at a time Review chart and complete formsUses Foot Controls XRepetition X 30-45 min at a time writingBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (COC-03)


COPYRIGHTED 8



Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Director Continuum of CareShift: 8AM to 5PM. Length of Shift: 8 Max. 1 Min. Hours per Wk: up to 40 hrs

EDUCATION/EXPERIENCE: Ability to understand simple oral and written instruction…good interpersonal relationship skills.

SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _X_

BRIEF DESCRIPTION: Assisting with office duties.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Continuum of Care office, telephone, fax, copier


DUTIES: Phone answering, filing, copying, taking referrals.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min Obtain suppliesWalking X 1-3 min Walking to work areaSitting X 30-45 min at a time Sitting at desk, sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying suppliesPush/Pull X intermittent Open drawersReaching X 2-5 x per day Overhead at times, obtain suppliesTwisting/Turning XBending X 6-12” from floor To obtain suppliesStoop/Squat X 6-12” from floor To obtain suppliesKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Performing clerical tasksUpper Extremity X 30-45 min at a time Performing clerical tasksUses Foot Controls XRepetition X 30-45 min at a time writingBalancing X


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Organization NameSample Description of Temporary Transitional Task: Entering Data (COC-04)



Temporary Transitional Task Supervisor: Director Continuum of Care

Shift: 8A-5P. Length of Shift: 2 Max. 1 Min. Hours per Wk: 10 hrs per /wk

EDUCATION/EXPERIENCE: Ability to understand simple oral and written instruction , keyboarding

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity_X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Entering data

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Continuum of Care office, computer


DUTIES: Entering data into computer.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min To obtain suppliesWalking X 1-3 min To obtain suppliesSitting X 30-45 min at a time Keyboarding sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching X <12 inches To obtain suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Keyboarding, can break as neededUpper Extremity X 30-45 min at a time Keyboarding, can break as neededUses Foot Controls XRepetition X 30-45 min Keyboarding, can break as neededBalancing X


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Organization NameSample Description of Temporary Transitional Task: Copying/Filing (CME-01)

Continuing Medical Education Department

Task Qualifications/Requirements/Training Category: Service Date: _____

Temporary Transitional Task Supervisor: CME Coordinator

Shift: 8-5. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...


BRIEF DESCRIPTION: General office assistance.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _Whiteout________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:General office environment


DUTIES: Distributing monthly calendars, preparing mailings, copying, filing, and compiling charts.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To use copying machineWalking X <15 feet To deliver calendarsSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 2 lbs.Push/PullReaching XTwisting/Turning XBending X To reach lower files Stoop/Squat XKneeling XCrawling XClimbing XHand Movement X Copying, filingUpper Extremity XUses Foot Controls XRepetition X Copying, filingBalancing X


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Organization NameSample Description of Temporary Transitional Task: Data Input/Graphing (EHS-01)

Employee Health Department


Temporary Transitional Task Supervisor: Injury CoordinatorShift: _8-5. Length of Shift: 4 Max. 2 Min. Hours per Wk: Up to 20 hrs.

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...High school graduate, ability to keep confidences.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination _X_ Hearing___

BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Employee Health office


DUTIES: Logging data into database and retrieving information in report format.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking XSitting X Can accommodate by standingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <2 lbs. Files/paperworkPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Typing, running reportsUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Office/Clerical Tasks (EHS-02)


COPYRIGHTED 12




Temporary Transitional Task Supervisor: Injury Coordinator

Shift: _8-5_. Length of Shift: 2 Max. 1 Min. Hours per Wk: 6-8 hrs/weekEDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...


BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Employee Health office


DUTIES: Occasional light typing, sending out employee notices, filing, alphabetizing microfilms.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 10-25 feetSitting X Can accommodate sit/standDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <2lbs. FilesPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Data Input: Graphing(EHS-03)


Task Qualifications/Requirements/Training Category: Service ____ Date: _____

Temporary Transitional Task Supervisor: Injury Coordinator______

Shift: _8-5_____. Length of Shift: 4_ Max. 2_ Min. Hours per Wk: Up to 20 hrs. __

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...High school graduate, ability to keep confidences.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination__X_ Hearing___BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Employee Health office


DUTIES: Logging data into database and retrieving information in report format.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking XSitting X Can accommodate by standingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <2 lbs. Files/paperworkPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Typing, running reportsUpper Extremity XUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Public Entrance Clean Up (ES-01)

Environmental Services Department

Task Qualifications/Requirements/Training Category: Service Date: ___________ Temporary Transitional Task Supervisor: Environmental Services SupervisorShift: 6:30A-3P, 3P-11: 30P, 10P-6: 30A. Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Ability to read and understand simple written and verbal instructions.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision _X_ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Cleaning public entrances.

DESCRIBE WORK ENVIRONMENT:% Inside 100_ % Outside: ___Works With Chemicals - Specify Glass and multi-purpose cleanser. Heat: __X___ Cold: _X____ Dust: ___X__ Noisy: __X___ Humid/Water: _X_____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Entire Hospital – Will work close to exterior doors, and could be exposed to cold/hot weather. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Utility______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield__X_ Head___ Shoe___DUTIES: Clean glass entrances; Dust ledges of entrance areas; vacuum entrances. Empty small trash containers.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15-30 min. or less Surveying area to cleanWalking X < 5 min. Work areaSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carries supplies which include germicide/rags/high duster- extends to 8 ft.

Push/Pull X Up to 20# force Pushes vacuumReaching X 12 inches Ability to reach to clean glass and other areasTwisting/Turning XBending X 5 min. or less Ability to bend when cleaning areaStoop/Squat X 5 min. or less Spot washing walls/glassKneeling XCrawling XClimbing XHand Movement X 30-45 min. a time Needs use of one hand to cleanUpper Extremity X 30-45 min. a time Needs use of one hand to cleanUses Foot Controls X 2-10 times Foot controls on vacuumRepetition X 2-10 times Performing cleaning activitiesBalancing X


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Organization NameSample Description of Temporary Transitional Task: Office Support (ES-02)


Task Qualifications/Requirements/Training Category: Tech/Serv/Prof Date: ________Temporary Transitional Task Supervisor: Environmental Services SupervisorShift: 8:00 – 4:30 p.m Length of Shift: _8 Max. _4 Min. Hours per Wk: _40_

EDUCATION/EXPERIENCE: Ability to understand simple written and verbal instructions.


BRIEF DESCRIPTION: Office assistance.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Environmental services office Exposure to noise from phone, office equipment and computers. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Answering telephone, take messages, filing, copying of documents. Activity Never Rare

0-25%Occasional

26-50%Frequent51-75%

Constant76-100%



Standing X Up to 5-10 min. Sit or stand option performing dutiesWalking X <5 min. To get to work areaSitting X 30-45 min. At desk in officeDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying suppliesPush/Pull X Intermittent Trouble shoot copier, file cabinet drawerReaching X 12 inches Filing, obtaining suppliesTwisting/Turning XBending X 6 inches from floor Add paper to copier, & filing Stoop/Squat X 6 inches from floor Add paper to copier, & filing Kneeling XCrawling XClimbing XHand Movement X 30-45 min. Use of one hand to write, file and use phoneUpper Extremity X 30-45 min. Use of one arm to write, file and use phoneUses Foot Controls XRepetition X 30-45 min. Filing, phone answering, sorting, & writing Balancing X


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Organization NameSample Description of Temporary Transitional Task: Utility Room Clean Up (ES-03)


Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: Environmental Services SupervisorShift: 6:30 a.m.-3:00 p.m., 3:00 p.m.-11:30 p.m., 10p.m. -6:30 a.m.Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40



BRIEF DESCRIPTION: Utility room clean up.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: __X___ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: __X___ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Utility rooms through out hospital. Medical waste exposure.

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__exam-utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_X__ Head___ Shoe___

DUTIES: Cleaning sinks, sweeping mopping floor, high dusting, spot cleaning walls, cleaning lights.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing x 30 or less Standing while cleaningWalking x 1-5 min To get from place to placeSitting xDriving xLifting (light) 10-20 lbs.

x 2-4 feet no more than 2 times

Needs to be able to lift medical waste plastic containers which may be 10-20 pounds.


x


x

Carrying x <5# SuppliesPush/Pull x 30 min or less Ability to push broomReaching x 12 inches To cleanTwisting/Turning x When manipulating waste boxesBending x Up to 10 min To clean could accommodateStoop/Squat xKneeling xCrawling xClimbing xHand Movement x Up to 30 min To cleanUpper Extremity x Up to 30 min To cleanUses Foot Controls xRepetition x Up to 30 min Pushing broom to cleanBalancing x


COPYRIGHTED 17


Organization NameSample Description of Temporary Transitional Task: Spot Cleaning (ES-04)


Task Qualifications/Requirements/Training Category: Service Date: _________ Temporary Transitional Task Supervisor: Environmental Services DirectorShift: 6:30A-3P, 3P-11: 30P, 10P-6: 30A. Length of Shift: 8 Max. 4 Min. Hours per Wk: up to 40


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision _X_ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Spot clean walls and doors.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify General purpose and glass cleaners_________________Heat: __X___ Cold: _X____ Dust: __X___ Noisy: _____ Humid/Water: __X____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Entire hospital

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_X__ Head___ Shoe___

DUTIES: Damp wipe fingerprints and any other dirt from walls and doors.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15-30 min. or less Surveying area to cleanWalking X < 5 min Work areaSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Caries supplies which include germicide/rags/high duster- extends to 8 ft.

Push/Pull X Up to 20# force Pushes vacuumReaching X 12 inches Ability to reach to clean glass and other areasTwisting/Turning XBending X 5 min or less Ability to bend when cleaning areaStoop/Squat X 5 min or less Spot washing walls/glassKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Needs use of one hand to cleanUpper Extremity X 30-45 min at a time Needs use of one hand to cleanUses Foot Controls X 2-10 times Foot controls on vacuumRepetition X 2-10 times Performing cleaning activitiesBalancing X


COPYRIGHTED 18


Organization NameSample Description of Temporary Transitional Task: Public Area and Meeting Room Clean Up (ES-05)


Task Qualifications/Requirements/Training Category: Service Date: __________Temporary Transitional Task Supervisor: Environmental Services Supervisor______Shift: 6:30A-3P, 3P-11:30A, 10P-6:30A. Length of Shift: 8 Max. 4 Min. Hours per Wk: _Up to 40_


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision _X_ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Dust and spot clean public areas.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify General purpose cleaner_________________Heat: _____ Cold: _____ Dust: __X___ Noisy: __X___ Humid/Water: __X____ Fumes: _____ Odors: __X___ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Entire Hospital PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield__X_ Head___ Shoe___DUTIES: Dust ledges, ceiling vents and any other surfaces assigned; Damp wipe walls, ledges and any other surfaces assigned.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min or less at a time

While stopped to sweep or pick up

Walking X 30-45 min at a time Walking corridorsSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 5 # Needs to carry light broom and dust panPush/Pull X Up to 20# force Pushing broom, move cartsReaching X 12 inches To perform cleaningTwisting/Turning XBending X 3 times/hr Optional activity while cleaningStoop/Squat X 3 times/hr Optional activity while cleaningKneeling XCrawling XClimbing X 7 levels Ability to climb stairs could accommodateHand Movement X 30-45 at a time Needs use of one hand to cleanUpper Extremity X 30-45 at a time Needs use of one arm to cleanUses Foot Controls XRepetition X 30-45 at a time To perform cleaning and sweepingBalancing X 7 levels stairs Stair climbing could accommodate

Organization NameSample Description of Temporary Transitional Task: Cleaning Elevator Tracks (ES-06)


COPYRIGHTED 19



Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Environmental Services SupervisorShift: 3P-11: 30PM, 10P-6: 30A. Length of Shift: 4 Max. 1 Min. Hours per Wk: Up to 20 hrsEDUCATION/EXPERIENCE: Able to read and understand simple written and verbal instructions.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision _X_ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Cleaning elevator tracks.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify General purpose cleaner_________________Heat: _____ Cold: _____ Dust: _X____ Noisy: ___X__ Humid/Water: _X_____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Entire hospital-elevators. Utilizes a vacuum, putty knife, stiff brush. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_X_ Head___ Shoe___DUTIES: Vacuum elevator tracks; clean elevator tracks.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 10 min or less Performing cleaning activitiesWalking X < 5 min Getting to work areaSitting X 30-45 min at a time Sits on floor or low stoolDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carries supplies-cleaners and rags

Push/Pull X 10# force Ability to push vacuumReaching X 12 inches or less Reaching to perform cleaning activitiesTwisting/Turning XBending X 30-45 min Ability to bend to clean tracks can alternate

between sit, kneel or bendStoop/Squat X 30-45 min Ability to stoop/squat to clean tracks, can

alternate between sit, kneel, or bendKneeling X 30-45 min May need to bend to clean tracks, can alternate

between sit, kneel or bendCrawling XClimbing XHand Movement X 30-45 min Needs use of one arm to cleanUpper Extremity X 30-45 min Needs use of one hand to cleanUses Foot Controls X 2-10 times Vacuum operationRepetition X 2-10 times Performing cleaning activitiesBalancing X

Organization NameSample Description of Temporary Transitional Task: Corridor and Stairwell Clean Up (ES-07)



COPYRIGHTED 20


Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: Environmental Services SupervisorShift: 6:30 A-3P, 3P-11: 30P, 10P-6: 30A_. Length of Shift: _8 Max. 2 Min. Hours per Wk: _up to 40_

EDUCATION/EXPERIENCE: Ability to read and understand simple written and verbal instructions.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception _X_ Peripheral Vision___ Color Discrimination___ Hearing Depth perception needed for stair climbing.

BRIEF DESCRIPTION: Walks corridors and stairwells of the hospital picking up or sweeping up debris.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify __General purpose cleaner_______________Heat: _____ Cold: _____ Dust: __X___ Noisy: _____ Humid/Water: ___X___ Fumes: _____ Odors: __X___ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Corridors and Stairwells of Hospital. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield__X_ Head___ Shoe___

DUTIES: Remove debris from corridors, public areas and stairwells; spot wipe walls- if able; dust ledges, if able.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min or less at a time

While stopped to sweep or pick up

Walking X 30-45 min at a time Walking corridorsSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 5# Needs to carry light broom and dust panPush/Pull X Up to 20# force Pushing broom more cartsReaching X 12 inches To perform cleaningTwisting/Turning XBending X 3 times/hr Optional activity while cleaningStoop/Squat X 3 times/hr Optional activity while cleaningKneeling XCrawling XClimbing X 7 levels Ability to climb stairs could accommodateHand Movement X 30-45 at a time Needs use of one hand to cleanUpper Extremity X 30-45 at a time Needs use of one arm to cleanUses Foot Controls XRepetition X 30-45 at a time To perform cleaning and sweepingBalancing X 7 levels stairs Stair climbing could accommodate

Organization NameSample Description of Temporary Transitional Task: Cafeteria and Other Departmental Clean Up (FNS-

01) Food and Nutrition Department

Task Qualifications/Requirements/Training Category: Service Date: ________ DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify Bleach, soap


COPYRIGHTED 21


Temporary Transitional Task Supervisor: Food Service DepartmentShift: 6A-3P, 11A-7P, 7:30p-3A Length of Shift: _8 Max. 4 Min. Hours per Wk: up to 40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions.


BRIEF DESCRIPTION: Clean stainless steel, Plexiglas, table tops, misc. items.

Heat: _____ Cold: _____ Dust: _____ Noisy: X Humid/Water: X Fumes: X Odors: X Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Cafeteria PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type Utility as needed Respirator - Specify TypeMask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield as needed Head___ Shoe___

DUTIES: Clean tabletop sanitize food contact service, push portable broom and replace salt and peppershakers. Polishing refrigerator and chaffing dishes.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min at a time To cleanWalking X 30-45 min Intermittent walkingSitting XDriving XLifting (light) 10-20 lbs.

X Carry small bucket of water 6-7 lbs.


X


X

Carrying X 1-3# Supplies to cleanPush/Pull X Up to 30 min Broom, could accommodateReaching X Up 24 inches Reaching to clean equipmentTwisting/Turning XBending X 30-45 min If able to bend pick-up debrisStoop/Squat X Up to 10 min If able, clean table legs and chairKneeling XCrawling XClimbing X 15-20 min daily Cleaning high areas, could accommodateHand Movement X 30-45 min To cleanUpper Extremity X 30-45 min To cleanUses Foot Controls XRepetition X cleaningBalancing X 15-20 min daily If able to use step stool, could accommodate

Organization NameSample Description of Temporary Transitional Task: Inventory Supplies (FNS-02)

Food and Nutrition Department

Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Food Service DirectorShift: 7:00 a.m.-3:30 p.m.. Length of Shift: 8 Max. 4 Min. Hours per Wk: 8 hrs-weekly task

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify Bleach________________Heat: _____ Cold: __X___ Dust: _____ Noisy: _X____ Humid/Water: ___X___ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Kitchen and nursing unit pantry


COPYRIGHTED 22




BRIEF DESCRIPTION: Inventory supplies


DUTIES: Taking inventory of refrigeration, dry goods, floor pantries and paper supplies.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-15 min at a time Taking inventoryWalking X 5 min or less Walking to inventorySitting XDriving XLifting (light) 10-20 lbs.

X 5-10 times Move case could accommodate


X


X

Carrying X 5# or less Carrying clipboard to write on, move itemsPush/Pull XReaching X 24 inches To count inventory if ableTwisting/Turning XBending X 20-25 times To count inventory if ableStoop/Squat X 20-25 times To count inventory if ableKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Needs use of one hand to write withUpper Extremity X 30-45 min at a time Needs use of arm to write withUses Foot Controls XRepetition X intermittent Writing down informationBalancing X

Organization NameSample Description of Temporary Transitional Task: Assembling Nutritional Information Packets

(FNS-03) Food and Nutrition Department

Task Qualifications/Requirements/Training Category: Service Date: __________Temporary Transitional Task Supervisor: Food Service DirectorShift: 5:30A-7: 30P. Length of Shift: 8 Max. 2 Min. Hours per Wk: Varies up to 8 hrs


DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Clinical Dietician’s Office


COPYRIGHTED 23



BRIEF DESCRIPTION: Assembling information packets.


DUTIES: Assemble nutritional information kits/packets.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min at a time Sit or stand optionWalking X 5 min or less Walking to work areas-minimalSitting X 30-45 min at a time Sit or stand optionDriving XLifting (light) 10-20 lbs.

X Lifting could be broken into small stacks


X


X

Carrying X <1-3# Carrying packetsPush/Pull X Light cart Could use cart to transfer, could accommodateReaching X <12 inches Reaching for literatureTwisting/Turning XBending X 10-20 times Box could be positioned, so it wouldn’t be a

need to bend, stoop or squat.Stoop/Squat X 10-20 times Box could be positioned, so it wouldn’t be a

need to bend, stoop or squat.Kneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Could use one hand assembling packetsUpper Extremity X 30-45 min at a time Could use one arm assembling packetsUses Foot Controls XRepetition X 30-45 min at a time Assembling packetsBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (FNS-04)



Temporary Transitional Task Supervisor: Food Service Director

Shift: Days. Length of Shift: 8 Max. 4 Min. Hours per Wk: up to 40


DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Food and Nutrition office

PERSONAL PROTECTIVE EQUIPMENT REQUIRED: Supervisor Signature: _______________________________________ Date: _____________________

COPYRIGHTED 24


SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing X

BRIEF DESCRIPTION: Assisting with office duties.

Gloves - Specify Type__Utility as needed_____________ Respirator - Specify Type_hair restraint______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_as needed__ Head___ Shoe___

DUTIES: Answering phones, take messages, filing, and data entry.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Up to 30 min Sit or stand option performing dutiesWalking X 1-3 min Walking to work areasSitting X 30-45 min Sit or stand performing dutiesDriving XLifting (light) 10-20 lbs.

X Lifting supplies under 10 lbs.


X


X

Carrying X 1-3# Carrying suppliesPush/Pull X intermittent Trouble shoot copier, file cabinet drawer.Reaching X 12 inches Filing, obtaining suppliesTwisting/Turning XBending X 6 inches from floor Filing if ability to bend.Stoop/Squat X 6 inches from floor Filing of ability to stoop or squatKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Use of one hand to write, file, and use phoneUpper Extremity X 30-45 min at a time Use of one arm to write, file, and use phoneUses Foot Controls XRepetition X 30-45 min at a time Writing and filingBalancing X

Organization NameSample Description of Temporary Transitional Task: Food Portioning and Light Food Preparation

Work(FNS-05) Food and Nutrition Department

Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: Food Service DirectorShift: 6A-3P, 11A-7P. Length of Shift: 8 Max. 4 Min. Hours per Wk: up to 40


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision___

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify Bleach_________________Heat: _____ Cold: ___X__ Dust: _____ Noisy: _____ Humid/Water: handwashing______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Kitchen, refrigerator PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_utility needed Respirator - Specify Type__hair restraint_____________


COPYRIGHTED 25


Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Portioning food and light food preparation.

Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_as needed__ Head___ Shoe___DUTIES: Individual portioning of food and placing it on dishes, light food preparation.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min a time Sit or stand optionWalking X <1 min Walking to work areasSitting X As needed Sit or stand optionDriving XLifting (light) 10-20 lbs.

X Up to 15# Needs to transfer dishe either individually or on sheet pan can accommodate


X


X

Carrying X Up to 10# To transfer food to cart, can break up loadPush/Pull X Up to 10 times Pushing cart with food items, could

accommodateReaching X 30-45 min at a time Reaching to portion food and prepare foodTwisting/Turning XBending X 5-6 times Could get assistance if foods on a lower shelf.Stoop/Squat X 5-6 times Stoop/squat, to transfer foods, could accom.Kneeling XCrawling XClimbing XHand Movement X 30-45 min at a time To portion and prepare food, could use one

handUpper Extremity X 30-45 min at a time To portion and prepare food, could use one armUses Foot Controls XRepetition X 30-45 min at a time To portion and prepare foodBalancing X

Organization NameSample Description of Temporary Transitional Task: Entering Data (FNS-06)


Task Qualifications/Requirements/Training Category: Service Date: _________Temporary Transitional Task Supervisor: Food Service DirectorShift: 7-3:30pm. Length of Shift: 8 Max. 2 Min. Hours per Wk: Varies up to 24 hrs

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions, keyboarding

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity __ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Clinical Dietician’s Office



COPYRIGHTED 26


BRIEF DESCRIPTION: Assembling information packets.DUTIES: Assemble nutritional information kits/packets.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min To obtain suppliesWalking X 1-3 min To obtain suppliesSitting X 30-45 min Keyboarding sit or stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching X <12 inches To obtain suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min at a time Keyboarding, can break as neededUpper Extremity X 30-45 min at a time Keyboarding, can break as neededUses Foot Controls XRepetition X 30-45 min at a time Keyboarding, can break as neededBalancing X

Organization NameSample Description of Temporary Transitional Task: Cafeteria and Other Departmental Clean Up(FNS-

07) Food and Nutrition Department

Task Qualifications/Requirements/Training Category: Service ____ Date: ______ Temporary Transitional Task Supervisor: Food Service Department______Shift: 6A-3P, 11A-7P, 7:30p-3A. Length of Shift: _8 Max. 4_ Min. Hours per Wk: up to 40hrs


SENSORY EFFECT/COMMUNICATION:Speech_X__ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Clean stainless steel, Plexiglas, table tops, misc. items.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _Bleach, soap________________Heat: _____ Cold: _____ Dust: _____ Noisy: ___x__ Humid/Water: __x____ Fumes: __X___ Odors: ___X__ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Cafeteria

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Utility as needed______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_as needed__ Head___ Shoe___

DUTIES: Clean tabletop sanitize food contact service, push portable broom and replace salt and peppershakers. Polishing refrigerator and chaffing dishes.


COPYRIGHTED 27



Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 min at a time To cleanWalking X 30-45 min at a time Intermittent walkingSitting XDriving XLifting (light) 10-20 lbs.

X Carry small bucket of water 6-7 lbs.


X


X

Carrying X 1-3# Supplies to cleanPush/Pull X Up to 30 min Broom, could accommodateReaching X Up 24 inches Reaching to clean equipmentTwisting/Turning XBending X Intermittent 30-45

minIf able to bend pick-up debris

Stoop/Squat X Up to 10 min If able, clean table legs and chairKneeling XCrawling XClimbing X 15-20 min daily Cleaning high areas, could accommodateHand Movement X 30-45 min at a time To cleanUpper Extremity X 30-45 min at a time To cleanUses Foot Controls XRepetition X cleaningBalancing X 15-20 min daily If able to use step stool, could accommodate

Organization NameSample Description of Temporary Transitional Task: Assistance with Safety Reviews (HSAF-01)

Health and Safety Department


Temporary Transitional Task Supervisor: Safety CoordinatorShift: 8AM-5PM. Length of Shift: 4 Max. 2 Min. Hours per Wk: _20_

EDUCATION/EXPERIENCE: Ability to understand oral & written instructions Ability to read numbers.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing___

BRIEF DESCRIPTION: Facility compliance survey.

DESCRIBE WORK ENVIRONMENT:% Inside __100_ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Checking fire extinguishers for appropriate pressures.

Activity Never Rare Occasional Frequent Constant Weight/Distance/ Activity Description


COPYRIGHTED 28


0-25% 26-50% 51-75% 76-100% Height/FrequencyStanding X To check extinguishersWalking X Must be able to walkSitting X CompileDriving X Drive to Penn campusLifting (light) 10-20 lbs.

X


X


X

Carrying X ClipboardPush/Pull XReaching X To open file cabinetTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X To write and to open file cabinetsUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Assistance with Office Tasks (HSAF-02)



Temporary Transitional Task Supervisor: Safety CoordinatorShift: 8-5. Length of Shift: 4_ Max. 2 Min. Hours per Wk: Up to 20

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...Ability to read.


BRIEF DESCRIPTION: Light typing, copying, filing

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify __Whiteout_______________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Safety office


DUTIES: Light word processing, copying, filing


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To use copy machine Supervisor Signature: _______________________________________ Date: _____________________

COPYRIGHTED 29


Walking X 10-15 feet Can accommodateSitting X Can accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <2lbs FilesPush/Pull XReaching XTwisting/Turning XBending X To reach lower files/can accommodateStoop/Squat X To reach lower files/can accommodateKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Assistance with Safety Reviews(HSAF-03)


Task Qualifications/Requirements/Training Category: Service ____ Date: _____

Temporary Transitional Task Supervisor: Safety Coordinator______

Shift: 8-5______. Length of Shift: 4_ Max. 2_ Min. Hours per Wk: _20_

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...Ability to read numbers.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination__X_ Hearing___BRIEF DESCRIPTION: Facility compliance survey.

DESCRIBE WORK ENVIRONMENT:% Inside __100_ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


DUTIES: Checking fire extinguishers for appropriate pressures.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To check extinguishersWalking X Must be able to walkSitting X CompileDriving X Drive to Penn campus/can accommodate by

working at only one campus or transportation to Supervisor Signature: _______________________________________ Date: _____________________

COPYRIGHTED 30


and from.Lifting (light) 10-20 lbs.

X


X


X

Carrying X ClipboardPush/Pull XReaching X To open file cabinetTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X To write and to open file cabinetsUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (IHCS-03)

Home Care Supply Department

Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _____ Temporary Transitional Task Supervisor: Clinical SupervisorShift: 8A-6P. Length of Shift: 8 Max. 2 Min. Hours per Wk: _15-24_

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...Phone etiquette


BRIEF DESCRIPTION: Clerical support

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Home Care Supply Dept. phone, copier, fax


DUTIES: Answering phones, taking messages, copying records, faxing info.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To copy, faxWalking X 50 ft. Within dept.Sitting X Sit/stand option-phonesDriving XLifting (light) 10-20 lbs.

X


COPYRIGHTED 31



X


X

Carrying X 1-3# Get papers to copy/faxPush/Pull X <1# Desk drawerReaching X 20-50 x hr Answer phonesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min.

intervalsPhones, fax, copy, writing

Upper Extremity X Phones, fax, copy, writingUses Foot Controls XRepetition X 20-50 x hr Answer phone, writingBalancing X

Organization NameSample Description of Temporary Transitional Task: Cleaning Equipment (IHCS-05


Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _______Temporary Transitional Task Supervisor: Clinical SupervisorShift: _8A-6P_. Length of Shift: 8 Max. 2 Min. Hours per Wk: 10-24_

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...Familiar with home care equipment and operation

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION:Clean Home Care equipment

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Spray bottle


DUTIES: Spraying and cleaning of equipment, changing filters


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30 min. interval To clean equip.Walking X 50 ft. To get equip.Sitting X Sit/stand optionDriving XLifting (light) 10-20 lbs.

X Could accommodate


X Could accommodate


X


COPYRIGHTED 32


Carrying X 1-3# Cleaning suppliesPush/Pull X Up to 20# For wheels to move equip.Reaching X 12-18”from body

occasionally overhead

Clean equip.

Twisting/TurningBending X To floor To reach bottom of equip.Stoop/Squat X To floor To reach bottom of equip.Kneeling X To reach bottom of equip.Crawling XClimbing XHand Movement X 30 min. intervals Moving and cleaning equip.Upper Extremity X 30 min. intervals Moving and cleaning equip.Uses Foot Controls XRepetition X 30 min. intervals cleaningBalancing X

Organization NameSample Description of Temporary Transitional Task: Filing (IHCS-06)


Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date:_____

Temporary Transitional Task Supervisor: Clinical Supervisor

Shift: _8A-6P_. Length of Shift: 8_ Max. 2_ Min. Hours per Wk: 10-40

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Filing medical records

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Home Supply area filing cabinets


DUTIES:Filing of medical records


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min. interval FilingWalking X 50 ft. To obtain recordsSitting X To sort papersDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carry papersPush/Pull X 10-20/hr File cabinets drawer


COPYRIGHTED 33


Reaching X 12” from Overhead-to fileTwisting/Turning XBending X 18” from floor File cabinetStoop/Squat XKneeling X To floor To file bottom drawerCrawling XClimbing XHand Movement X 30-45 min. interval Filing-carry-sorting papersUpper Extremity 30-45 min. intervalUses Foot ControlsRepetition X 30-45 min. interval Filing-sorting and carry papersBalancing

Organization NameSample Description of Temporary Transitional Task: Chart Reviewing (IHCS – 01)


Task Qualifications/Requirements/Training Category: Prof/Tech Date_________Temporary Transitional Task Supervisor: Clinical CoordinatorShift: 8 AM-5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk:_40 EDUCATION/EXPERIENCE: RN,LPN,RRT

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Review patient charts.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Ingham Home Care Supply office


DUTIES: Review charts for content and appropriate clinical documentation.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min/8 Obtain suppliesWalking X 5/min/ds Reach work areaSitting X 1 hr Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3 lbs. SuppliesPush/Pull X 6/hr Obtain charts, could accommodateReaching X 6/hr/12” Obtain charts, could accommodateTwisting/Turning XBending X 6/hr Obtain supplies, could accommodate


COPYRIGHTED 34


Stoop/Squat XKneeling XCrawling XClimbing XHand Movement X Intermittent Turn papers, obtain supplies and writingUpper Extremity X Intermittent Turn pages, obtain supplies and writingUses Foot Controls XRepetition X Intermittent WritingBalancing X

Organization NameSample Description of Temporary Transitional Task: Data Entry (IHCS – 02)


Task Qualifications/Requirements/Training Category: Serv/Tech/Prof Date: ________ Temporary Transitional Task Supervisor: Clinical Services Supervisor

Shift: 8 AM -5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Keyboard experience.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Entering data in computer.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Ingham Home Care Supply office, computer and printer.


DUTIES: Entering data in computer.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min, 10-20 times At printer, could accommodateWalking X 5 min, 10-20 times To work area, could accommodateSitting X 45 min-1 hr Could sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3#, 10-20 times Office supplies, could accommodatePush/Pull X 1-5 times a day Drawer to fill printer, could accommodateReaching X 12” not above

shoulderSupplies, could accommodate

Twisting/Turning XBending X 12” from floor Filing paper in printer, could accommodate


COPYRIGHTED 35


Stoop/Squat X 12” from floor Filing paper in printer, could accommodateKneeling XCrawling XClimbing XHand Movement X Intermittent KeyboardingUpper Extremity X Intermittent KeyboardingUses Foot Controls XRepetition X Intermittent KeyboardingBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (IHCS – 03)


Task Qualifications/Requirements/Training Category: Tech/Serv Date: ________ Temporary Transitional Task Supervisor: Clinical Coordinator

Shift: _8 AM –5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. Ability to record information and organizational skills, knowledge of office machines.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_BRIEF DESCRIPTION: Provide clerical support.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Ingham Home Care Supply office


DUTIES: Data entry, filing, copying, answering phones, mailings


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min/hr To obtain suppliesWalking X 5 min/hr Get to work areaSitting X 1 hr at a time Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# suppliesPush/Pull X 20-25/hr Filing patient chartsReaching X 20-25/hr 12” Filing patient chartsTwisting/Turning XBending X 6/hr Filing patient chartsStoop/Squat X


COPYRIGHTED 36


Kneeling XCrawling XClimbing XHand Movement X Intermittent Data entry, filing, writingUpper Extremity X Intermittent Data entry, filing, writingUses Foot Controls XRepetition X Intermittent Data entry, filing, writingBalancing X

Organization NameSample Description of Temporary Transitional Task: Warehouse Support (IHCS – 04)


Task Qualifications/Requirements/Training Category: Service Date:________Temporary Transitional Task Supervisor: Operations CoordinatorShift: _8 AM – 5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions.SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity___ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Process and price inventory.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: seasonal_____ Cold: seasonal_____ Dust: _X__ Noisy: __X_ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _O2____ Ventilation: _____Machines, Tools, Equipment and Work Area: Ingham Home Care Supply Warehouse PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___DUTIES: Check in coming freight to PO and price as directed.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-15 min Checking suppliesWalking X 5-15 min approx.

250”Checking supplies

Sitting X 5-15 min, 5 x day Paper workDriving XLifting (light) 10-20 lbs.

X 10-20 x per day Equipment, could accommodate


X 5-10 x per day Equipment, could accommodate


X

Carrying X 1-10#, 15-20 x per day

Equipment and supplies, could accommodate

Push/Pull X Loading dock cart Cart, could accommodateReaching X 12 inch; 10-20 x

per dayEquipment and supplies, could accommodate

Twisting/Turning XBending X 12 inches from

floorEquipment and supplies, could accommodate

Stoop/Squat X 12 inches from floor


Kneeling X 12 inches from floor


Crawling X


COPYRIGHTED 37


Climbing X 12 ft ladder Obtain suppliesHand Movement X 45 min at a time Pricing, handling supplies, could accommodateUpper Extremity X 45 min at a time Pricing, handling supplies, could accommodateUses Foot Controls XRepetition X 45 min at a time PricingBalancing X

Organization NameSample Description of Temporary Transitional Task: Cleaning Equipment (IHCS – 05)


Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ________


Shift: _8A-6P Length of Shift: 8 Max. 2 Min. Hours per Wk: 10-24

EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions. Familiar with home care equipment and operationSENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION:Clean Home Care equipment

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Spray bottle


DUTIES:Spraying and cleaning of equipment, changing filters


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30 min. interval To clean equip.Walking X 50 ft. To get equip.Sitting X Sit/stand optionDriving XLifting (light) 10-20 lbs.

X Could accommodate


X Could accommodate


X

Carrying X 1-3# Cleaning suppliesPush/Pull X Up to 20# For wheels to move equip.Reaching X 12-18”from body Clean equip., occasionally overheadTwisting/TurningBending X To floor To reach bottom of equip.Stoop/Squat X To floor To reach bottom of equip.Kneeling X To reach bottom of equip.Crawling XClimbing X


COPYRIGHTED 38


Hand Movement X 30 min. intervals Moving and cleaning equip.Upper Extremity X 30 min. intervals Moving and cleaning equip.Uses Foot Controls XRepetition X 30 min. intervals cleaningBalancing X

Organization NameSample Description of Temporary Transitional Task: Filing (IHCS-06)


Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ________


Shift: _8A-6P Length of Shift: 8 Max. 2 Min. Hours per Wk: 10-40

EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION:Filing medical records

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Home Supply area filing cabinets


DUTIES:Filing of medical records


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min. interval FilingWalking X 50 ft. To obtain recordsSitting X To sort papersDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carry papersPush/Pull X 10-20/hr File cabinets drawerReaching X 12” from Overhead-to fileTwisting/Turning XBending X 18” from floor File cabinetStoop/Squat XKneeling X To floor To file bottom drawerCrawling XClimbing X


COPYRIGHTED 39


Hand Movement X 30-45 min. interval Filing-carry-sorting papersUpper Extremity 30-45 min. intervalUses Foot ControlsRepetition X 30-45 min. interval Filing-sorting and carry papersBalancing

Organization NameSample Description of Temporary Transitional Task: Telephone Answering & Messages (IHCS-07)


Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _____


Shift: 8A-6P Length of Shift: 8 Max. 2 Min. Hours per Wk: _15-24_

EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions. Phone etiquetteSENSORY EFFECT/COMMUNICATION:Speech__X_ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Clerical support.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Home Care Supply Dept. phone, copier, fax


DUTIES: Answering phones, taking messages, copying records, faxing info.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To copy, faxWalking X 50 ft. Within dept.Sitting X Sit/stand option-phonesDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Get papers to copy/faxPush/Pull X <1# Desk drawerReaching X 20-50 x hr Answer phonesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min. interval Phones, fax, copy, writing


COPYRIGHTED 40


Upper Extremity X Phones, fax, copy, writingUses Foot Controls XRepetition X 20-50 x hr Answer phone, writingBalancing X

Organization NameSample Description of Temporary Transitional Task: Data Entry (IHCS-08)


Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ________ Temporary Transitional Task Supervisor: Clinical SupervisorShift: 8A-6P Length of Shift: _8_ Max. _2__ Min. Hours per Wk: 14 EDUCATION/EXPERIENCE: Ability to understand oral & written instructions computer literacy and keyboard experience


BRIEF DESCRIPTION: Data entry

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Computer Home Care Supply Dept. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Entering data into computer system.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Sit/stand optionWalking X <100 ft Within areaSitting X 45 min. intervals Data entryDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Binder-could accommodatePush/Pull X 1-2 times/shift Basic powerReaching X 12”from To reach paperTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min. interval TypingUpper Extremity X 30-45 min. interval TypingUses Foot Controls X


COPYRIGHTED 41


Repetition X 30-45 min. interval TypingBalancing X

Organization NameSample Description of Temporary Transitional Task: Assisting in Clinical Lab Area (LAB-01)

Laboratory Department

Task Qualifications/Requirements/Training Category: Technical Date: ________Temporary Transitional Task Supervisor: General lab supervisorShift: all- 24 hrs/day Length of Shift: _8 Max. _4 Min. Hours per Wk: 40_

EDUCATION/EXPERIENCE: Medical Technologist- license or eligible

SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception X Peripheral Vision___ Color Discrimination X Hearing X

BRIEF DESCRIPTION: Technical assistance in clinical lab area.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify ______________________ Heat: _____ Cold: _____ Dust: _____ Noisy: X Humid/Water: X Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Laboratory , general lab instrumentation. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Exam Gloves Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield __ Head___ Shoe___

DUTIES: Sub-culturing, cataloging, and freezers stock and QC organisms in microbiology, set of cultures, review labs, perform differentials, general microscopic analysis.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min inter. Sit or stand option. To obtain supplies.Walking X <5 min inter. Walking from area to area to obtain supplies.Sitting X 45-60 min Sit or stand optionDriving XLifting (light) 10-20 lbs.

X Lab supplies or lab ware under 10 lbs.


X


X

Carrying X <5# Could utilize cart, suppliesPush/Pull XReaching X 12 inches Reaching to obtain supplies Twisting/Turning XBending X To 110-120 degrees Put spec. in instruments- could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Needs both hands manipulating specimensUpper Extremity X 45-60 min Needs both arms manipulating specimensUses Foot Controls X


COPYRIGHTED 42


Repetition X 45-60 min Manipulating specimens.Balancing X

Organization NameSample Description of Temporary Transitional Task: Assisting in General Lab (LAB-02)


Task Qualifications/Requirements/Training Category: Tech/Serv Date: _________

Temporary Transitional Task Supervisor: Gen. Lab Supervisor

Shift: _7A-5P. Length of Shift: 8 Max. 2 Min. Hours per Wk: 40

EDUCATION/EXPERIENCE: Ability to oral and written instructions. Lab experience

SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing X Brief Description: Assisting in the Lab in a variety of general tasks

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: ____ Dust: _____ Noisy: _____ Humid/Water: XFumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Laboratory PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _____________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield __ Head___ Shoe___

DUTIES: Filing (paper and glass slides), cleaning equipment, washing glassware, inventory, unpacking/labeling supplies.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min To perform taskWalking X 5-10 min inter. Walking from area to areaSitting X 5-10 min inter. Sit or stand optionDriving XLifting (light) 10-20 lbs.



X


X

Carrying X <10# Could utilize cart. Put items awayPush/Pull X 100# on cart Cart lab supplies and equipment.Reaching X 12-14 in Reaching to obtain from shelving overhead.Twisting/Turning XBending X Floor level Place items on bottom shelfStoop/Squat X Floor level Place items on bottom shelfKneeling XCrawling XClimbing XHand Movement X 45-60 min Filing and labeling.Upper Extremity X 45-60 min Filing, and labeling.Uses Foot Controls XRepetition X 45-60 min Manipulating filing, labeling.Balancing X


COPYRIGHTED 43


Organization NameSample Description of Temporary Transitional Task: Assisting Central Processing (LAB-03)


Task Qualifications/Requirements/Training Category: Tech. /Serv. Date: ________ Temporary Transitional Task Supervisor: Gen. Lab supervisor

Shift: 5AM-10:30PM Length of Shift: _8 Max. 2 Min. Hours per Wk: 40_

EDUCATION/EXPERIENCE: Oriented to lab, tech. Asst., med technologistSENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing X

BRIEF DESCRIPTION: Receiving specimens

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: __x___ Humid/Water: Handwashing______ Fumes: ___X__ Odors: ___X__ Gases: _____ Ventilation: _____Infectious substancesMachines, Tools, Equipment and Work Area:Laboratory, centrifuge, computer esPERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type___Exam____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___DUTIES: Verification of specimens distribution to laboratory areas, enter computer information assist in central processing posting lab reports. General specimen processing and distribution preparing specimens for send.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min inter. Sit or stand optionWalking X 45-60 min inter. Walking to deliver and collect specimensSitting X 15-20 min Sit or stand option, enter dataDriving XLifting (light) 10-20 lbs.

X Lifting specimens and patient reports less than 10 lbs.


X


X

Carrying X 1-5 Carrying specimens and patients reports.Push/Pull XReaching X 12-14 inch Reaching to remove specimens, high to open

centrifuge.Twisting/Turning XBending X 12 in. from floor To obtain supplies, could stoop instead of bend.Stoop/Squat X 12 in. from floor To obtain supplies, could stoop instead of bend.Kneeling XCrawling XClimbing XHand Movement X 45-60 min Both hands for computer and labeling task.Upper Extremity X 45-60 min Both arms for computer and labeling task.


COPYRIGHTED 44


Uses Foot Controls XRepetition X 45-60 min Labeling and computer task.Balancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (LAB-04)

Lab Department

Task Qualifications/Requirements/Training Category: Service Date: _________

Temporary Transitional Task Supervisor: Lead Technical AssistantShift: _7A-11P. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40EDUCATION/EXPERIENCE: Ability to understand simple oral and written work, instruction, must have laboratory experience.SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing X

BRIEF DESCRIPTION: Provide general office support for lab.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Lab front office, fax and copy machine, computer, telephonePERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Greeting patients, looking up results, sending faxes, copying materials, review orders, schedule, collating reports, filing.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min Stand to copy, perform tasksWalking X 5 min To complete tasksSitting X 45-60 min Performing taskDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# SuppliesPush/Pull X 24 in Open glass windowReaching X 24 in Open glass windowTwisting/Turning XBending X 12 in. from floor File reports- could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min inter. Perform tasks, could wear headsetUpper Extremity X 45-60 min inter. Perform tasks, could wear headset.


COPYRIGHTED 45


Uses Foot Controls XRepetition X 45-60 min inter. Writing, computer look upBalancing X

Organization NameSample Description of Temporary Transitional Task: Outpatient Blood Drawing (LAB-05)

Lab Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________Temporary Transitional Task Supervisor: General Lab SupervisorShift: 6A-8:30P. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Experience or training in phlebotomy.SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _X_

BRIEF DESCRIPTION: Phlebotomy

DESCRIBE WORK ENVIRONMENT:% Inside __100_ % Outside: ___Works With Chemicals - Specify _Soaps________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: Hand washing______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Exposure biohazardMachines, Tools, Equipment and Work Area: Outpatient phlebotomy

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_as needed__ Head___ Shoe___

DUTIES: Outpatient phlebotomy.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-5 min To draw blood- could accommodateWalking X <5 min To obtain supplies, orders- could accommodateSitting X 30-40 min Sit or stand option to draw bloodDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <1-3# Sharps, paperworkPush/Pull XReaching X <12 inches Drawing bloodTwisting/Turning XBending X 110-120 degree Drawing blood- could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min Drawing bloodUpper Extremity X 30-45 min Drawing blood


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Uses Foot Controls XRepetition X 30-45 min Drawing bloodBalancing X

Organization NameSample Description of Temporary Transitional Task: Transporting Specimen (LAB-06)

Lab Department

Task Qualifications/Requirements/Training Category: Serv . _ Date: ________Temporary Transitional Task Supervisor: Lead Technical Asst.Shift: 5:00A-7:00A S-S Greenlawn 8:30A-6P Penn.Length of Shift: _2-Greenlawn 8-Penn Max. 2 Min. Hours per Wk: Up to 14

EDUCATION/EXPERIENCE: Ability to understand simple oral work, written instruction, knowledge on blood/body fluid clean up.


BRIEF DESCRIPTION: Transporting lab specimens to lab.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Blood/Body fluidsMachines, Tools, Equipment and Work Area: Entire hospital, es PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Pick up samples on nursing unit and deliver to lab.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min To pick up specimenWalking X 2 hours interm. Entire hospitalSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <1-5# Lab specimensPush/Pull X 2 hours, inter. Light cartReaching X 12 inches To obtain specimenTwisting/Turning XBending X <1-2 x shift Spill clean up- could accommodateStoop/Squat X <1-2 x shift Spill clean up- could accommodateKneeling XCrawling XClimbing X


COPYRIGHTED 47


Hand Movement X 2 hrs, interm. To pick up specimenUpper Extremity XUses Foot Controls XRepetition X 5-10 Pick up specimenBalancing X

Organization NameSample Description of Temporary Transitional Task: Assisting with Pathology QA (LAB-07)


Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________ Temporary Transitional Task Supervisor: Office CoordinatorShift: 8a – 5p Length of Shift: _8 Max. _1_ Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Simple math, alphabetizing, collating data, copyMachine

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Assisting with Pathology quality assurance and general clerical duties.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: X Odors: X Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Pathology Department computer


DUTIES: Collation of Pathology data and general clerical duties.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing x Depends on volume at card filesWalking XSitting X 45-60 minutes Sit or stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1 –3 pounds Supplies, notebookPush/Pull X 80 # of times Opening file cabinetsReaching X Obtain suppliesTwisting/Turning XBending X 12” from floor Lower file cabinetsStoop/Squat XKneeling XCrawling XClimbing XHand Movement x 45-60 minutes Intermittent data collation and coding


COPYRIGHTED 48


Upper ExtremityUses Foot Controls XRepetition X 45-60 minutes Intermittent writing/pulling/filing reportsBalancing X


COPYRIGHTED 49


Organization NameSample Description of Temporary Transitional Task: Assisting in Clinical Lab Area (LAB-08)

Laboratory DepartmentTask Qualifications/Requirements/Training Category: Technical ____ Date: _______ Temporary Transitional Task Supervisor: General lab supervisor______

Shift: all- 24 hrs/day__. Length of Shift: _8 Max. _4 Min. Hours per Wk: _Up to 40_

EDUCATION/EXPERIENCE: Medical Technologist- license or eligibleSENSORY EFFECT/COMMUNICATION:Speech__X_ Visual Acuity___X Depth Perception_X__ Peripheral Vision___ Color Discrimination__X_ Hearing_X__BRIEF DESCRIPTION: Technical assistance in clinical lab area.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify Cleaning agents___________ Heat: _____ Cold: _____ Dust: _____ Noisy: __X___ Humid/Water: __X____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____ Infectious SubstanceMachines, Tools, Equipment and Work Area: Laboratory, general lab instrumentation.

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Exam_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield_as needed__ Head___ Shoe___

DUTIES: Sub-culturing, cataloging, and freezers stock and QC organisms in microbiology, set of cultures, review labs, perform differentials, general microscopic analysis.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min inter. Sit or stand option. To obtain supplies.Walking X <5 min inter. Walking from area to area to obtain supplies.Sitting X 45-60 min Sit or stand optionDriving XLifting (light) 10-20 lbs.



X


X

Carrying X <5# Could utilize cart, suppliesPush/Pull XReaching X 12 inches Reaching to obtain supplies or manipulate spec.Twisting/Turning XBending X To 110-120 degrees Put spec. in instruments- could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Needs both hands manipulating specimens,

could accommodateUpper Extremity X 45-60 min Needs both arms manipulating specimens,

could accommodateUses Foot Controls XRepetition X 45-60 min Manipulating specimens.Balancing X


COPYRIGHTED 50


Organization NameSample Description of Temporary Transitional Task: Grounds Maintenance Support (MAINT-01)

Maintenance and Engineering Department

Task Qualifications/Requirements/Training Category: Service Date: _______Temporary Transitional Task Supervisor: Gregg ObergShift: 7A-11P. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40 hrs/wk

EDUCATION/EXPERIENCE: ABLE TO READ AND UNDERSTAND WRITTEN AND VERBAL INSTRUCTION.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Parking lot services for visitors.

DESCRIBE WORK ENVIRONMENT:% Inside ___ % Outside: _100__Works With Chemicals - Specify __OIL_______________Heat: _X____ Cold: __X___ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Outside on hospital grounds, plastic bag, scooper, washrag. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Answering questions in the visitor’s lot and pushing button to lift gate for cars.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 2 min increments To pick up or spread salt.Walking X Must be able to walk entire hospital grounds.Sitting X Can sit to take breaks as neededDriving X 3 mi. To go from one campus to anotherLifting (light) 10-20 lbs.

X


X


X

Carrying X <1# trash bag Hospital campus will carry plastic trash bag while picking up trash.

Push/Pull XReaching X <12” from body Pick up trash and spread salt.Twisting/Turning XBending X 12” from ground To pick up trashStoop/Squat X 12” from ground To pick up trashKneeling XCrawling XClimbing XHand Movement X To pick up trash and spread salt.Upper Extremity X To pickup trash and spread salt.Uses Foot Controls X 3 mi. To drive carRepetition XBalancing X


COPYRIGHTED 51


Organization NameSample Description of Temporary Transitional Task: Changing Light Bulbs (MAINT-02)


Task Qualifications/Requirements/Training Category: Service Date: _____ Temporary Transitional Task Supervisor: Greg Oberg Shift: 7-3:30, 3:30-11. Length of Shift: 8 Max. 2-3 Min. Hours per Wk: 16-40 hrs/wk


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Changing light bulbs.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


DUTIES: Changing light bulbs, including fluorescent bulbs.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To change bulb.Walking X ½ block From one location to another.Sitting X As neededDriving X To go to other campus-3 mi.Lifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull X Pushing cart from one location to the next.Reaching 2 min increments Need to reach overhead to change bulbs.Twisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing X Majority of bulbs require climbing on 6 ft.

ladder to reach.Hand Movement X To push cart and change bulbs.Upper Extremity X To change bulbs and push cart.Uses Foot Controls X To drive 3 mi.Repetition XBalancing X On ladder


COPYRIGHTED 52


Organization NameSample Description of Temporary Transitional Task: Maintenance Support (MAINT-03)


Task Qualifications/Requirements/Training Category: Service Date: _____Temporary Transitional Task Supervisor: Gregg ObergShift: 7AM-11PM. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: ABILITY TO READ AND UNDERSTAND WRITTEN AND VERBAL INSTRUCTION.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Cleaning and stocking

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: __X___ Cold: __X___ Dust: __X___ Noisy: ___X__ Humid/Water: __X____ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Mechanical rooms, powerhouse PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Utility_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Clean powerhouse and mechanical rooms, stock bins.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15 min increments Stand to wash- can sit/stand sometimes-can accommodate

Walking X ½ block 2 x day To get from one location to the other to clean.Sitting X Can sit to stock and wash as needed.Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carry rags, cleaning suppliesPush/Pull X 3-5# Push broom to sweepReaching X Mechanical roomsTwisting/Turning <12” from body To cleanBending X <12” from floor To cleanStoop/Squat X <12” from floor To cleanKneeling XCrawling XClimbing X Washing, pushing broomHand Movement X Washing, pushing broomUpper Extremity XUses Foot ControlsRepetition X 5 min increments Washing and holding broomBalancing X

Organization Name Supervisor Signature: _______________________________________ Date: _____________________

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Sample Description of Temporary Transitional Task: Office Support (MAINT-04)Maintenance and Engineering Department

Task Qualifications/Requirements/Training Category: HS Degree Date: _____ Temporary Transitional Task Supervisor: Sandy CarlShift: 7:30-4. Length of Shift: 8 Max. 4 Min. Hours per Wk: 20-40hrs/wk


SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Office duties

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: __X___ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Phone, fax, copier PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___DUTIES: Mail sorting and carrying, answering phone, filing.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 10 min/hr Filing, mail and memo distributionWalking X 1 x day less than 1

blockTo go to mail room

Sitting X Answering phone, writing, mail sortingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Lift preventative maintenance book to file.Push/Pull XReaching X 10 min/hr All the way to the floor to arm level, filing and

distribute memos.Twisting/Turning XBending X Floor level to file-can sit to fileStoop/Squat X Floor level to file-can sit to fileKneeling XCrawling XClimbing XHand Movement X Mail sorting, phone answering, filingUpper Extremity X Filing, distribute memos, answer phone, writingUses Foot ControlsRepetition X 10 min increments To answer phone, writing, file-can

accommodateBalancing


COPYRIGHTED 54


Organization NameSample Description of Temporary Transitional Task: Assisting in Parking Lot (MAINT-05)



Temporary Transitional Task Supervisor: Gregg Oberg

Shift: 7-3:30. Length of Shift: 8 Max. _ Min. Hours per Wk: __



BRIEF DESCRIPTION: Parking lot services for visitors.

DESCRIBE WORK ENVIRONMENT:% Inside ___ % Outside: 100-in booth___Works With Chemicals - Specify _________________Heat: ___?__ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Push button, visitor parking lot


DUTIES: Answering questions in visitor lot and pushing button to lift gate for cars.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X As needed to stretch.Walking X ½ block To get to hospital for lunch or breaks.Sitting X As much as needed in control booth.Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull X Will vary Push button to lift gate when car pulls in.Reaching X To reach button to lift gate as needed.Twisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Push button to lift gate.Upper Extremity X To push button.Uses Foot Controls XRepetition X Push button.Balancing X


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Organization NameSample Description of Temporary Transitional Task: Vehicle Washer (MAINT-06)



Temporary Transitional Task Supervisor: Gregg ObergShift: 7A-11P Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40_

EDUCATION/EXPERIENCE: ABLE TO READ AND UNDERSTAND WRITTEN AND VERBAL INSTRUCTION.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity___ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Wash vehicles

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _OIL________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Water hose, wash area PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Wash hospital trucks and cars.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15-30 min increments

To wash-can accommodate

Walking X Walk around vehicle to washSitting X Can sit as neededDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Wash rags and towelsPush/Pull X 1-3# Wash rags and towels

Reaching X 12” from body To washTwisting/Turning XBending X 24” from body To wash bottom of vehicleStoop/Squat XKneeling XCrawling XClimbing X 1 ft off ground To reach top of vehicleHand Movement X Washing and holding sprayerUpper Extremity XUses Foot Controls XRepetition X Washing and holding sprayerBalancing


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Organization NameSample Description of Temporary Transitional Task: Parking Lot Guard/Attendant (MAINT-07)



Temporary Transitional Task Supervisor: Gregg Oberg

Shift: 7-3:30. Length of Shift: 8 Max. _ Min. Hours per Wk: __



BRIEF DESCRIPTION: Parking lot services for visitors.

DESCRIBE WORK ENVIRONMENT:% Inside ___ % Outside: 100-in booth___Works With Chemicals - Specify _________________Heat: ___?__ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Push button, visitor parking lot


DUTIES: Answering questions in visitor lot and pushing button to lift gate for cars.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X As needed to stretch.Walking X ½ block To get to hospital for lunch or breaks.Sitting X As much as needed in control booth.Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull X Will vary Push button to lift gate when car pulls in.Reaching X To reach button to lift gate as needed.Twisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Push button to lift gate.Upper Extremity X To push button.Uses Foot Controls XRepetition X Push button.Balancing X


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Organization NameSample Description of Temporary Transitional Task: Library Support (MLIB-01)

Medical Library Services Department

Task Qualifications/Requirements/Training Category: Service Date: ____ Temporary Transitional Task Supervisor: Judy BarnesShift: 8:30-4:30. Length of Shift: 8 hr Max. 1 hr Min. Hrs per Wk: 20-40 wk


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity___ Depth Perception___ Peripheral Vision___ Color Discrimination X-some Hearing___BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___DUTIES: Read shelves, match circulation with collection, sort mail, copy fiche, address and mail ills, process books.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Read shelves, matching circ. with collection.Walking X Read shelves, matching circ. with collectionSitting X Sort mail, copying fiche, addressing and

mailing ills and processing books.Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5# Carrying books, journalsPush/Pull X Push cart with books-can adjust cart load to

needs-can accommodate.Reaching X 10 min / hr < 12 in Putting books off and on shelf.Twisting/Turning XBending X 10min/hr 12” off

floorLower shelf to put books back.

Stoop/Squat X 10 min/hr Lower shelf 6” off floor, to shelve books, can accommodate with stool.

Kneeling XCrawling XClimbing XHand Movement X All list duties as above.Upper Extremity X Process books, copying fiche, sorting mail.Uses Foot ControlsRepetition X 15 min increments Can be accommodated- to copy fiche.Balancing


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Organization NameSample Description of Temporary Transitional Task: Record Photocopying (MR-01)

Medical Records Department

Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Manager Medical Records.Shift: 8-4:30pm, 3-11pm Length of Shift: 8 Max. 4 Min. Hours per Wk: up to40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions. Knowledge of hospital reports. For identification in record.

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: __ Odors:__ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Medical photocopier, microfiche, or microfilm PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _______________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___



Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 30-45 min Standing at photocopier, Can accommodateWalking X 1-2 min To various work areas Sitting X 30-45 min Microfiche/microfilm work sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5#. Charts, can utilize cartPush/Pull X Light cart 1-2 min Only if cart utilizedReaching X 12 in To retrieve cartTwisting/Turning XBending X 6 in from floor Obt. Unjamming photocopier can squat/kneelStoop/Squat X 6 in from floor Obt. Unjamming photocopier can squat/kneelKneeling X 6 in from floor Obt. Unjamming photocopier can squat/kneelCrawling XClimbing XHand Movement X 30-45 min PhotocopyingUpper Extremity X 30-45 min PhotocopyingUses Foot Controls XRepetition X 30-45 minBalancing X


COPYRIGHTED 59


Organization NameSample Description of Temporary Transitional Task: Loose Filing Organization (MR-02)


Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Manager Medical Records.Shift: 8-4:30pm, 3-11:30pm Length of Shift: 8 Max. 4 Min. Hours per Wk: up to40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions. Computer skills helpful, numerical sorting, name sortingSENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination __ Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: __ Odors:__ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Medical records, computer, manual sorter PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _______________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___



Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <1 min To pick up file folderWalking X 1-2 min To pick up file folderSitting X 30-45 min To alphabetize and attach recordsDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5#. Carry folders, can accommodate with cartPush/Pull X Light cart 1-2 min Only if cart utilizedReaching X 5-10 times a day To obtain from shelf and replace, overheadTwisting/Turning XBending X 6 in from floor Obtain folders/can choose to squat/kneelStoop/Squat X 6 in from floor Obtain folders/can choose to squat/kneelKneeling X 6 in from floor Obtain folders/can choose to squat/kneelCrawling XClimbing XHand Movement X 30-45 min Alphabetize, sort and assembleUpper Extremity X 30-45 min Alphabetize, sort and assemble gUses Foot Controls XRepetition X 30-45 min Alphabetize, sort and assembleBalancing X


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Organization NameSample Description of Temporary Transitional Task: Reviewing Clinical Pertinence (MR-03)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv. Date: ________Temporary Transitional Task Supervisor: Manager Medical Records.Shift: 8-4:30pm, 3-11:30pm Length of Shift: 8 Max. 4 Min. Hours per Wk: up to40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions. Credentialed medical records tech, RN, LPN, or technical level or above.SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination __ Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: __ Odors:__ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Medical records PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _______________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___



Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <1 min To pick up file chartWalking X 1-2 min To pick up file chartSitting X 30-45 min To review charts sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5#. Carry charts, can accommodate with cartPush/Pull X Light cart 1-2 min Only if cart utilizedReaching X 1-3 times a day To obtain from chart, can accomodateTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 min Review documentsUpper Extremity X 30-45 min Review documentsUses Foot Controls XRepetition X 30-45 min Review documentsBalancing X


COPYRIGHTED 61


Organization NameSample Description of Temporary Transitional Task: Alphabetizing Outpatient and ER Records (MR- 04)


Task Qualifications/Requirements/Training Category: Service Date: ________Temporary Transitional Task Supervisor: Manager Medical Records.Shift: 8-4:30pm, 3-11:30pm Length of Shift: 8 Max. 4 Min. Hours per Wk: up to40

EDUCATION/EXPERIENCE: Ability to understand oral and written instructions. Able to alphabetizeSENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination __ Hearing___

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: __ Odors:__ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Medical records, manual sorter PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify _______________ Respirator - Specify _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___



Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <1 min To pick up file folderWalking X 1-2 min To pick up file folderSitting X 30-45 min To alphabetize and attach recordsDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5#. Carry folders, can accommodate with cartPush/Pull X Light cart 1-2 min Only if cart utilizedReaching X 5-10 times a day To obtain from shelf and replace, overheadTwisting/Turning XBending X 6 in from floor Obtain folders/can choose to squat/kneelStoop/Squat X 6 in from floor Obtain folders/can choose to squat/kneelKneeling X 6 in from floor Obtain folders/can choose to squat/kneelCrawling XClimbing XHand Movement X 30-45 min Alphabetize, sort and assembleUpper Extremity X 30-45 min Alphabetize, sort and assemble gUses Foot Controls XRepetition X 30-45 min Alphabetize, sort and assembleBalancing X


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Organization NameSample Description of Temporary Transitional Task: Clinical Support (NEURO-01)

Neurodiagnostics Department

Task Qualifications/Requirements/Training Category: H.S. Degree Date: _____

Temporary Transitional Task Supervisor: Operations SupervisorShift: 7:30-4:30. Length of Shift: _8 Max. 1-2 Min. Hours per Wk: 40


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Room set up

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__Vinyl____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Room set-up (linen change, cleaning probes) and setting up for next procedure.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 10 min/q hr Bed change, cleaning equipment, could accommodate

Walking X 20 ft/q hr To go from to room to set upSitting X 5-10 min/2-3 x hr Sit and stand at will, cleaningDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Equipment, linen, suppliesPush/Pull XReaching X 5-10 min q hr Bed changeTwisting/Turning XBending X 5 min/q x hr Bed changeStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Cleaning, bed change, moving suppliesUpper Extremity X Linen change, moving supplies, cleaningUses Foot Controls XRepetition X 5 min increments Bed changeBalancing X


COPYRIGHTED 63


Organization NameSample Description of Temporary Transitional Task: Office Support (NEURO-02)

Neurodiagnostics Department

Task Qualifications/Requirements/Training Category: Service,Technical,Professional Date: _____ Temporary Transitional Task Supervisor: OperationsShift: 7:30-4:00. Length of Shift: _8 Max. 1 Min. Hours per Wk: 50

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...HS education, need background in background medical technology for scheduling

SENSORY EFFECT/COMMUNICATION:Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Office duties

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Neurodiagnostic telephone, copy machine, fax


DUTIES: Answering telephone, scheduling, file, compiling and set up of charts.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15 min 2 x day To complete filing, could accommodateWalking X 5 min 2 x day To copy files, could accommodateSitting X 45 min Sit and stand at will, schedule chart compilingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carry filesPush/Pull XReaching X Not greater than 12

in.Filing, compiling chart

Twisting/Turning XBending X To 12” off floor Low filing, could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Compiling charts, writing, etc…Upper Extremity X Compiling charts, writing, etc…Uses Foot Controls XRepetition X 15 min increments Writing, compiling charts, could accommodateBalancing X


COPYRIGHTED 64


Organization NameSample Description of Temporary Transitional Task: Accompanying Patients-Professional (NUR-01)

Nursing Department

Task Qualifications/Requirements/Training Category: _Professional Date: ________ Temporary Transitional Task Supervisor: Nurse Manager/Administrative Supervisor

Shift: 7A – 11P Length of Shift: 3 Max. 1 Min. Hours per Wk: 5-18 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work, instruction. RN license

SENSORY EFFECT/COMMUNICATION: Speech_X__ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination__X_ Hearing__X_BRIEF DESCRIPTION: Professional personnel accompanying patient off unit

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Medical center cardiac monitor specific for areas w/advance technical monitoring.

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Resuscitation efforts, telemetry monitoring, vital signs

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 20-30 min Assessing pt.Walking X 10-15 min Accompanying pt.Sitting X 10-15 min Waiting on patientDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 2-20 times Stethoscope, B/P cuff, suppliesPush/Pull XReaching X 12 inch Taking vital signsTwisting/Turning X 2-20 times Take vital signsBending X 2-20 times Assessing patientStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 2-20 times Writing, assessing patientUpper Extremity X 2-20 times Writing, assessing pt.Uses Foot Controls XRepetition X 2-20 times Writing, assessing pt.


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Balancing X

Organization NameSample Description of Temporary Transitional Task: Answering Patient Call Lights (NUR-02)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech/Prof. Date: _________ Temporary Transitional Task Supervisor: Nursing Mgr../Admin. SupervisorShift: All 3 shifts. Length of Shift: _8_ Max. _2__ Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand oral & written instructions

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing X

BRIEF DESCRIPTION: Answer call lights

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Call light system, phone PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Answer pt. call lights and direct assistance as needed.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X As neededWalking X <50 ft. To find appropriate personSitting X 30-45 min To locate personsDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X <15 times/hr Pick up receiverUpper Extremity X <15 times/hr Pick up receiverUses Foot Controls XRepetition X <15 times/hr Picking up receiverBalancing X


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Organization NameSample Description of Temporary Transitional Task: Answering Patient Call Lights (NUR-03)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv /Tech/Prof. Date: _________ Temporary Transitional Task Supervisor: Nursing Manager/Administrative SupervisorShift: All 3 shifts Length of Shift: 8 Max. 2 Min. Hours per Wk: 40/wk EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Answer call lights

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Call light system, phone


DUTIES: Answer pt. call lights and direct assistance as needed.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X As neededWalking X <50 ft. To find appropriate personSitting X 30-45 min To locate personsDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X <15 times/hr Pick up receiverUpper Extremity X <15 times/hr Pick up receiverUses Foot Controls XRepetition X <15 times/hr Picking up receiverBalancing X


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Organization NameSample Description of Temporary Transitional Task: Bath Set-Ups (NUR-04)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: _________ Temporary Transitional Task Supervisor: Nursing Man./Admin. SupervisorShift: 7AM-7:30PM Length of Shift: 5 Max. _2 Min. Hours per Wk:_10-25 EDUCATION/EXPERIENCE: Ability to understand oral & written instructions

SENSORY EFFECT/COMMUNICATION: Speech_X__ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Assisting patients with set up of baths and minimal washing

DESCRIBE WORK ENVIRONMENT:% Inside __100_ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type Vinyl/Latex_ Respirator - Specify Type_______________Mask X Gown X Scrubs X Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Obtain and set up bath water and toweling assist with washing back or legs if necessary.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 15-30 min. intervals

Washing pt.

Walking X 1-3 min interval Obtain water & linenSitting X As able to accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 3-5# Carry linen & water for bathPush/Pull XReaching X 12”from body To get linen and water pt. room to roomTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 5-30 min interval Obtaining supplies/bathingUpper Extremity X Obtaining supplies, bathingUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Blood Drawing (NUR-05)

NURSING, MRICU, SICU, 4N, CICU, 6N Department

Task Qualifications/Requirements/Training Category: Professional Date: ________ Temporary Transitional Task Supervisor: Nursing mgr./ Admin. SupervisorShift: All 3 shifts Length of Shift: 2 Max. 1 Min. Hours per Wk: 5-10 EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction…


DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type latex Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Blood draws from arterial, central or heplock lines.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 2-5 minute intervals

Draw blood from access site

Walking X 2 min intervals From room to room as neededSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <1# 2 min intervals Blood draw suppliesPush/Pull XReaching X 12” from body To reach linesTwisting/Turning XBending X 12” over Down to patient lineStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 15-30 min intervals Carry supplies, drawing bloodUpper ExtremityUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Chart Breakdown (NUR-06)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech/Prof. Date: _________ Temporary Transitional Task Supervisor: _Nursing Mgr/Adminis. SupervisorShift: _All 3 shifts Length of Shift: _2_ Max. _1__ Min. Hours per Wk:_5-10 EDUCATION/EXPERIENCE:

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity_X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Breakdown chart after discharge

DESCRIBE WORK ENVIRONMENT:% Inside _100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves – Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Take chart apart for Medical Records to pick up after discharge.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing x As neededWalking x 1-2 minutes To get to areaSitting x 45-60 minutes Can stand as neededDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying x <3 pounds < 15 feet To carry chart from one desk to anotherPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement x 30-45 minutes Separating papersUpper Extremity x 30-45 minutes Separting papersUses Foot Controls XRepetition X 45-60 minutes Taking papers apartBalancing x


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Organization NameSample Description of Temporary Transitional Task: Chart Set-Up (NUR-07)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech/Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing Manager/Admin SupervisorShift: All 3 Length of Shift: _2 Max. _1_ Min. Hours per Wk: 5 – 10 EDUCATION/EXPERIENCE:

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Setting up new charts for admission.

DESCRIBE WORK ENVIRONMENT:% Inside _100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: None


DUTIES: Setting up charts for new admissions.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing x As neededWalking X < 20 feet at a time To obtain PAC kitsSitting X Could stand as neededDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying < 3 pounds Carry packets to set up chartPush/PullxReaching x 12” from body Could be overhead Twisting/Turning XBending xStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 minutes Placing papers togetherUpper Extremity x 45-60 minutes Putting papers togetherUses Foot Controls XRepetition x 45-60 minutes Putting papers togetherBalancing


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Organization NameSample Description of Temporary Transitional Task: Copy Charts (NUR-08)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing Mgr./Admin SupervisorShift: 7A-11:30P Length of Shift: _2 Max. _1__ Min. Hours per Wk: 5-10 EDUCATION/EXPERIENCE: Ability to understand oral written instructions


BRIEF DESCRIPTION: Copying, fax medical records for other facilities

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Copier, fax


DUTIES: Copying/fax medical records to prepare for transfers to other facilities.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 30 min. At copier to copy notesWalking X <100 yds To get to copierSitting X 45-60 min. Can be accommodatedDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <100 yds To carry chart to copierPush/Pull X 1-3# Obtain chartsReaching X 5# on rolling cart To push heavy charts on cart, place paper on

copierTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min To copy, separate papersUpper Extremity X 45-60 min On copier, if necessaryUses Foot Controls XRepetition X 45-60 min On copier, if necessaryBalancing X


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Organization NameSample Description of Temporary Transitional Task: IV Starts (NUR-09)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing Mgr./Admin. SupervisorShift: All 3 shifts Length of Shift: _2_ Max. __1_ Min. Hours per Wk: 5-10 EDUCATION/EXPERIENCE: Ability to understand oral & written work instructions, RN

SENSORY EFFECT/COMMUNICATION: Speech__X_ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: IV Starts

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_latex______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Stat IV’s and set up with hep lock, IV tubing, assist with medical procedures.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 10-15 min. interval To start IVWalking X 2 min. interval Within unit as ableSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 5 min. interval Supplies for IV startPush/Pull XReaching X 12” from bodyTwisting/Turning X To get to right position for pt.Bending X To reach pt.Stoop/Squat XKneeling XCrawling XClimbing XHand Movement X 10-15 min.

intervalsStarting IV-sticking

Upper Extremity X 10-15 min. intervals

Set up of tubing

Uses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Nursing Assessments (NUR-10)

Nursing Department

Task Qualifications/Requirements/Training Category: Professional. Date: ________ Temporary Transitional Task Supervisor: Nursing Mgr./Administrative SupervisorShift: 7p-7a. Length of Shift: 8 Max. 2 Min. Hours per Wk: Up to 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions. RN licensure

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing X

BRIEF DESCRIPTION: Completing nursing assessments

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Syst. Momanometer, stethoscope, patient rooms, nursing unit

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Conducting assessments to include inspection, palpation, auscultation, and 12 to 32 pt. unit


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X While performing assessWalking X 1-3 min. To area of workSitting X 30-45 min. interval While performing history portion of assess.Driving XLifting (light) 10-20 lbs.

X 0-12 times May need to assist pt. to perform assess, but could obtain help





Carrying XPush/Pull XReaching X 12 inches or less No overhead reaching required, but reaches to

auscultate, palpateTwisting/Turning X 24-64 times During ausultation and palpation to support pt,

but may obtain assist.Bending X 24-64 times During ausultation and palpation to support pt.,

but may obtain assist.Stoop/Squat XKneeling XCrawling XClimbing XHand Movement X 24-64 times Need both handsUpper Extremity X 24-64 times Need both handsUses Foot ControlsRepetition X Planing writingBalancing


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Organization NameSample Description of Temporary Transitional Task: Passing Nutritional Supplements (NUR-11)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________ Temporary Transitional Task Supervisor: Nurse Manager/ Administrative SupervisorShift: 7p.m – 7 a.m., 7 a.m.–7 p.m. Length of Shift: 2 Max. 2 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand oral and written work instructions.SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Passing nutritional supplements

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify _OIL_____________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Pantry, Halls, Patient Rooms, Tray, Water Mugs, Cart, Dishes & Utensils PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___DUTIES: Passing snack, nutritional supplements, water to residents

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 1-20 MIN Can be intermittent, could accommodateWalking X 690 feet Down halls, patient rooms, could accommodateSitting X If needed to sit could accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3 # Mugs, individual snack, could accommodatePush/Pull X < app. 10# force Nutritional cart-lightReaching X 180 times over 4

hrsPassing water and snacks, could accommodate

Twisting/Turning XBending X 24” off the floor To obtain ice, could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 180 times over 4

hrsPassing water and snacks

Upper Extremity X 180 times over 4 hrs

Passing water and snacks

Uses Foot Controls XRepetition X 180 times over 4

hrsPassing water and snacks

Balancing X


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Organization NameSample Description of Temporary Transitional Task: Order Notation (NUR-12)

Nursing Department

Task Qualifications/Requirements/Training Category: Professional Date: __________ Temporary Transitional Task Supervisor: Pat. Care Manager/ Administrative SupervisorShift: 7A – 7P Length of Shift: 8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions. RN computer skill


BRIEF DESCRIPTION: Taking and noting physician’s orders.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Nursing station telephone


DUTIES: Take verbal physician orders


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 5 min To the work unitSitting X 45-60 min Sit or stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Charts, paperworkPush/Pull X 1-3# Obtain chartsReaching X 12 inch Obtain chartsTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min intervals Writing, noting ordersUpper Extremity X 45-60 min intervals Writing , noting ordersUses Foot Controls XRepetition XBalancing X


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Organization NameSample Description of Temporary Transitional Task: Patient Sitter (NUR-13)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof./Serv./ Tech. Date: ________

Temporary Transitional Task Supervisor: Patient Care Manager/ Administrative Sup. Shift: 7:30 a.m. – 4 p.m., 3:30 p.m. – 12 a.m., 11:30 p.m. – 8 a.m. Length of Shift: 8 Max. 8 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to read and follow instructions. RN or LPN attendants may be used for patient sitting on floors, but only Psyche attendants may patient sit on Psyche unit. Competency specific to specialty units i.e. psyches.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision X Color Discrimination___ Hearing X

BRIEF DESCRIPTION: Sets with patients for purpose of observation.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: X Hand washing___ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Patient rooms. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type Exam_______________ Respirator - Specify Type Possible if TB diagnosis, must be fit tested.______________Mask X Gown X (if isolation)__ Scrubs___ Glasses/Goggles/Face Shield X Head___ Shoe___

DUTIES: Observe patient at all times. This may include, but not limited to, patients who are suicidal, confused or are in the process of detoxifying. In the event of crisis, must contact nursing personnel immediately.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Accompanying and observing patientWalking X Accompanying and observing patientSitting X 30-40 min. int. Accompanying and observing patientDriving XLifting (light) 10-20 lbs.

X Offering support to patient if ambulatory


X


X

Carrying X <5# Assist with fluids , nutrition, urinalPush/Pull XReaching X 12” from body Get to patientTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 12” from body To provide support and assist patientsUpper Extremity X 12” from body To provide support to patientsUses Foot Controls XRepetition XBalancing X

Organization Name


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Sample Description of Temporary Transitional Task: Patient Feeding (NUR-14)Nursing Department

Task Qualifications/Requirements/Training Category: Serv./ Tech./ Prof. Date: _______ Temporary Transitional Task Supervisor: Nurse Manager/Administrative SupervisorShift: 7A-7P, 7P-7A Length of Shift: 8 Max. 2 Min. Hours per Wk:_Up to 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written instructions.

SENSORY EFFECT/COMMUNICATION: Minimum CAN certification requiredSpeech X Visual Acuity X Depth Perception X Peripheral Vision___ Color Discrimination___ Hearing X

BRIEF DESCRIPTION: Refill paper towels, soap dispenser and toilet tissue

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: Food____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Dining Room, Resident Room Or sunroom. Table Utensil.


DUTIES: Feeding residents


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-3 Min. 1-3 times per hour, could accommodateWalking X 25-30 feet 1-3 times per hour, could accommodateSitting X 15 min. – 1 hr Could stand to feed, could accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3 times per hr., could accommodatePush/Pull XReaching X Approx. 12 in. To feed patients, could sit close to residentTwisting/Turning XBending X To 12” off the floor To obtain tray, could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 1-3 patients/hr Feeding residentsUpper Extremity X 1-3 patients/hr Feeding residentsUses Foot Controls XRepetition X 1-3 patients/hr Feeding residentsBalancing X

Organization Name Supervisor Signature: _______________________________________ Date: _____________________

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Sample Description of Temporary Transitional Task: Restocking Paper Supplies (NUR-15)Nursing Department

Task Qualifications/Requirements/Training Category: Serv./ Tech./ Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing manager/ Administrative Supervisor Shift: All 3 shifts. Length of Shift: __ Max. 1 Min. Hours per Wk: 5 per week EDUCATION/EXPERIENCE: Ability to understand simple oral and written instructions.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Restock paper bins on unit

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


DUTIES: Restock paper supplies used on units.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15 minutes at a time

Can sit/stand

Walking X <100 yards To get paper and go from one unit to another.Sitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <3# Paper supplies to put in binPush/Pull XReaching X 12” from body To get paper off shelfTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 30-45 minute

intervalsPlace papers in bin

Upper Extremity X 30-45 minute intervals

Place papers in bin

Uses Foot Controls XRepetition X 15 minute intervals To separate papers and place in binBalancing X

Organization Name


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Sample Description of Temporary Transitional Task: Assist With Special Projects (NUR-16)Nursing Department

Task Qualifications/Requirements/Training Category: Tech./Serv./Prof. Date: _________ Temporary Transitional Task Supervisor: Director of Acute Care Shift: 7a.m. – 5 p.m. Length of Shift: 8 Max. 4 Min. Hours per Wk: Negotiable EDUCATION/EXPERIENCE: Secretarial, Technical, Professional (i.e. RN, LPN)

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___

BRIEF DESCRIPTION: Assist with special projects: Unit QA, CQI Monitors, Help Ed. Coordinator on various project development.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify _Rare_____________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Within the hospital , copier


DUTIES: Filing; Compile modules and manuals; Compile data from QA monitors; Various tasks-mostly office related.

Never Rare0-25%

Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 1-5 Minute

IntervalsWithin the hospital

Sitting X 30-40 MinuteIntervals

Sit-Stand option

Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3 # Papers, BindersPush/Pull X 1-5 x Hr File cabinets, doorsReaching X 12” from body Obtain papers, bindersTwisting/Turning X 12” from floor File cabinetBending XStoop/SquatKneeling XCrawling XClimbing XHand Movement X 30-45 minute int. Sorting papers, filingUpper Extremity X 30-45 Minute int. Placing papers in bindersUses Foot Controls XRepetition X 30 Minute intervals Separating papersBalancing X Filing


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Organization NameSample Description of Temporary Transitional Task: Supplying Rooms (NUR-17)

Nursing/CICU/6N Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date: ________ Temporary Transitional Task Supervisor: Nursing Manager/Administrative SupervisorShift: 7A-7P, 7P-7A Length of Shift: 6 Max. 2 Min. Hours per Wk: 30 EDUCATION/EXPERIENCE: Ability to understand simple oral and written instructions.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Replenish supplies

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Patient rooms


DUTIES: Placing supplies in room. Replace sharp containers


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <1-3 min. Place pts in roomsWalking X Interm. Place pts in roomsSitting XDriving XLifting (light) 10-20 lbs.

X Supplies <10#


X


X

Carrying X <10# Supplies could be put on cartPush/Pull X Light cart Supplies could be put on cartReaching X 12” from body Stocking suppliesTwisting/Turning XBending X 12” from Stocking suppliesStoop/Squat X Stocking supplies could stoop instead of bendKneeling XCrawling XClimbing XHand Movement X 5 min., inter. Stocking supplies, one handUpper Extremity X 5 min., inter. Stocking supplies, one handUses Foot Controls XRepetition X 5 min. inter. Stocking suppliesBalancing X


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Organization NameSample Description of Temporary Transitional Task: Transporting Ambulatory Patients (NUR-18)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date: ________ Temporary Transitional Task Supervisor: Nursing Mgr./Administrative SupervisorShift: 7A-11P Length of Shift: 3 Max. 1 Min. Hours per Wk: 5-18 EDUCATION/EXPERIENCE: Ability to understand simple oral and written instructions.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Assisting ambulatory pt’s to go to car upon D/C or to testing sites.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


DUTIES: Assisting ambulatory pt’s to get to car upon D/C or to other testing areas in the hospital.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 10-15 min. Entire hospital bldg.Sitting X 10-15 min. While waiting to transport pt.Driving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull 100-300# On cart or wheelchairReaching 12” from body Steady pt’s armTwisting/Turning XBending X 6” over 6 times/hr To assist pt. to standStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 15-30 min. interval Holding onto W/C or cartUpper Extremity X 15-30 min. intervalUses Foot Controls XRepetition XBalancing X


COPYRIGHTED 82


Organization NameSample Description of Temporary Transitional Task: Vital Signs (NUR-19)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof./ Tech./ Serv. Date: ________ Temporary Transitional Task Supervisor: Nurse Manger/Administrative SupervisorShift: 7A-7P Length of Shift: 2 Max. 1 Min. Hours per Wk: 5-10 EDUCATION/EXPERIENCE: Ability to understand simple oral and written instructions. RN, LPN, NA, MA, Clinical experience SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Taking patient vital signs

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Patient rooms, sphygmomanometer, stethoscope PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Exam_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Take B/P, temperature, pulse, respiration


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min. intermit While taking vital signsWalking X 50-70 feet To patient roomsSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Clipboard, stethoscope, B/P cuffPush/Pull X Every 6 hrs.

intermittentPortable B/P cuff

Reaching X 12 inches Taking vital signsTwisting/Turning X 24-64 times Taking vital signsBending X 24-64 times To put B/P cuff on pt. armStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 24-64 times

intermit.Vital signs

Upper Extremity X 24-64 times intermit.

Vital signs

Uses Foot Controls XRepetition X 24-64 times Vital signsBalancing X


COPYRIGHTED 83


Organization NameSample Description of Temporary Transitional Task: Answering Phones (NUR-20)

Nursing Department

Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing Manager/Administrative SupervisorShift: All 3-Day and Afternoon Length of Shift: 8 Max. 2 Min. Hours per Wk: 40

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction…


BRIEF DESCRIPTION: Answering telephone on unit

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Phone PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Answering phones, taking messages, and routing p.c. appropriately.Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X Only as neededWalking X 50 ft. To get nurse or others

Sitting X 15-30 min. Answering phone and take messageDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull XReaching 12 in from body Answering phoneTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 50-100 calls/day Answering phone-writingUpper Extremity X 50-100 calls/day Answering phone-writingUses Foot Controls XRepetition X 50-100 x day Answering phone-could accommodate

w/headsetBalancing X


COPYRIGHTED 84


Organization NameSample Description of Temporary Transitional Task: Medication Prep & Administration (NUR-21)

Nursing Department

Task Qualifications/Requirements/Training Category: Prof. Date: ________ Temporary Transitional Task Supervisor: Nursing Mgr./Admin. SupervisorShift: 4:00 p.m.-8:00 p.m./6:00 p.m.-10:00 p.m Length of Shift: 12 Max. 8_ Min. Hours per Wk:_40 if 4 hour max should be 6:00 a.m.-10:00 a.m. (chemstrip coverage)adult critical care, icu/ccu. EDUCATION/EXPERIENCE: Ability to read and follow instructions. May place injured workers who have job classifications of RN or LPN.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception X Peripheral Vision X Color Discrimination X Hearing X

BRIEF DESCRIPTION: Prepare and Administer Medication.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: __ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Patient Care Areas PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type EXAM Respirator - Specify Type Fit Tested For Resp. Iso.Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Frequent communication with care manager regarding preparation and documentation of medication administration. Also able to perform blood glucose monitoring. Perform IV rounds and restarts as necessary.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-10 Min. Prep. & administration of medsWalking X 500 ft for 30 Pt Un. Prep. & administration of medsSitting X 5-10 Minutes/Hour Sit during iv starts & chartingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <1-3# Need to carry ivs & medicationsPush/Pull XReaching X App. 45x /8Hrs. Prep. Medication/hanging iv bagsTwisting/Turning X Prep. Medication/hanging iv bagsBending X App. 10-15x/Hour Admin. Medications & ivsStoop/Squat X Approx. 1-5 x/Hr. Administering medications & ivsKneeling X Approx. 1-5 x/Hr. Administering medications & ivsCrawling XClimbing XHand Movement X 30 Patient Unit Admin. Med.ications/chartingUpper Extremity X 30 Patient Unit Admin. Medications/chartingUses Foot Controls X 15-30x/8 Hours To lock medication cartsRepetition X 30 Patient Unit Admin. Medications/chartingBalancing X

Organization Name


COPYRIGHTED 85


Sample Description of Temporary Transitional Task: General Office Tasks (PBIL-01)Physician Billing, IR Home Care, Patient Accounts Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date: _____ Temporary Transitional Task Supervisor: Supervisor Patient Accounts_Shift: 8-4:30. Length of Shift: 8 Max. 4_ Min. Hours per Wk: _Up to 40 hrs/week_

EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction ...Ability to read, alphabetize, write, basic keyboard knowledge

SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination__X_ Hearing___

BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify whiteout_________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Office, warehouse (cement store)


DUTIES:Filing, vouchers, sorting, pulling records, writing, microfishing, answering phone, routing calls, report distribution, sorting and distributing daily billing, search/find lost documents, online inquires


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Copying, filingWalking X Approx. 50 yardsSitting XDriving XLifting (light) 10-20 lbs.Lifting(medium) 21-50 lbs.

X Boxes of files, can accommodate


X

Carrying X Pieces of paperPush/Pull X Can accommodateReaching XTwisting/Turning X Confines aislewaysBending X Can accommodateStoop/Squat X Can accommodateKneeling X Can accommodateCrawling XClimbing X Step stools, can accommodateHand Movement X Can accommodateUpper Extremity XUses Foot Controls X Can accommodateRepetition X Can accommodateBalancing X Can accommodate


COPYRIGHTED 86


Organization NameSample Description of Temporary Transitional Task:Chart Purging (PMGMT-01)

Practice Management Department

Task Qualifications/Requirements/Training Category: Serv./Prof./Tech Date: ________Temporary Transitional Task Supervisor: Contact Practice Management Admin. Asst. Practice Manager

Shift: _8 AM-5 PM Length of Shift: _8_ Max. _4__ Min. Hours per Wk:20-40 EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction…no history of substance abuse.

SENSORY EFFECT/COMMUNICATION: Speech_X_ Visual Acuity_X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Recording and storing patient charts.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Practice


DUTIES: Logging charts on a record sheet, filling out forms, putting charts in cardboard boxes and labeling.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 20% To obtain suppliesWalking X 10% To obtain charts and suppliesSitting X 70% Sitting at work station, recordingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 25% Placing each chart in boxPush/Pull X 25% Pulling from shelvesReaching XTwisting/Turning XBending X To floor To obtain chart, could accommodateStoop/Squat X To floor Could do instead of bendingKneeling XCrawling XClimbing XHand Movement X 100% Writing, labeling, moving chartsUpper Extremity X 100% Writing, labeling, moving chartsUses Foot Controls XRepetition X 100% Writing, labeling, moving chartsBalancing X 12 inches On footstool to obtain chart


COPYRIGHTED 87


Organization NameSample Description of Temporary Transitional Task: Copy Charts (PMGMT-02)


Task Qualifications/Requirements/Training Category: Serv./Prof./Tech Date: ________ Temporary Transitional Task Supervisor: Contact: Practice Management Admin. Asst. Practice ManagerShift: _8 AM -5_PM_ Length of Shift: _8_ Max. _4__ Min. Hours per Wk: 20-40 EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction…no history substance abuse. SENSORY EFFECT/COMMUNICATION: Speech__X_ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Copying patient charts/records.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Practice


DUTIES: Breaking down a chart and copying such page and reassembling chart.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 20-30 min Standing at copy machineWalking X 5 min Collecting charts from placesSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5 lbs. 1-5 lbs. (one chart)Push/Pull X 10-20 charts Pulling charts from shelvesReaching X 12 inches Reaching for patient chartsTwisting/Turning XBending X To floor To obtain chart, could accommodateStoop/Squat X To floor Could do instead of bendingKneeling X To floor Could do instead of bendingCrawling XClimbing XHand Movement X 45-60 min,

IntermittentCopying chart

Upper Extremity X 45-60 min Intermittent

Copying chart

Uses Foot Controls XRepetition X 45-60 min,

IntermittentCopying chart

Balancing X


COPYRIGHTED 88


Organization NameSample Description of Temporary Transitional Task: Filing (PMGMT-03)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv Date: _________ Temporary Transitional Task Supervisor: Practice Manager / Practice Mgt. Admin. Asst. Shift: _Days 8 AM - 5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: 20-40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. No history of substance abuse.

SENSORY EFFECT/COMMUNICATION: Speech_X Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination_X__ Hearing_X__BRIEF DESCRIPTION: Organizing/sorting patient charts, filing patient charts.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:

PERSONAL PROTECTIVE EQUIPMENT REQUIRED: PracticeGloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Organizing/sorting patient charts, filing.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 20-30 min Filing chartsWalking X <5 min To files, around office to callerSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 10 lbs. Could accommodatePush/Pull XReaching X 12 inches Filing chartsTwisting/Turning XBending X Floor level Filing chartsStoop/Squat X Floor level Filing chartsKneeling XCrawling XClimbing XHand Movement X 45-60 min Filing, movingUpper Extremity X 45-60 min Filing, movingUses Foot Controls XRepetition X 45-60 min Filing, movingBalancing X < 5 min Could accommodate/step ladder


COPYRIGHTED 89


Organization NameSample Description of Temporary Transitional Task: Inventory Drug Sample (PMGMT-04)


Task Qualifications/Requirements/Training Category: Tech/Prof/Serv Date: ________ Temporary Transitional Task Supervisor: Contact Practice Management Admin. Asst. Practice ManagerShift: _8 AM-5 PM Length of Shift: 2 Max. 1 Min. Hours per Wk: 5 to 10 EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction…no history substance abuse.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Drug sample inventory.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Practice

PERSONAL PROTECTIVE EQUIPMENT REQUIRED: noneGloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Checking expiration dates on sample medications.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 45-60 min-int. Check samplesWalking X 45-60 min-int. To throw out expirated medsSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Medication samples-can accommodatePush/Pull XReaching X 12 inches To top and bottom shelf- can accommodateTwisting/Turning XBending X Floor level To floor levelStoop/Squat X Floor level To reach meds on bottom shelf-can

accommodateKneeling X Floor level To reach meds on bottom shelf-can

accommodateCrawling XClimbing X 12 inches On stool to reach top shelf-can accommodateHand Movement X 45-60 min Reaching for medsUpper Extremity X 45-60 min Reaching for medsUses Foot Controls XRepetition X 45-60 min Reaching for medsBalancing X 12 in On stool


COPYRIGHTED 90


Organization NameSample Description of Temporary Transitional Task: Patient Calling (PMGMT-05)


Task Qualifications/Requirements/Training Category: Prof/Tech Date: ________ Temporary Transitional Task Supervisor: Contact: Practice Management Admin. Asst. ManagerShift: _8 AM-5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40 EDUCATION/EXPERIENCE: No history substance abuse, RN or LPN licensure, specialty physician office practices management experience required.

SENSORY EFFECT/COMMUNICATION: SpeechX Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Triaging patient call.



DUTIES: Triaging patient calls, document phone calls, calling in prescriptions, boarding surgeries.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min, intermittent To obtain chart.Walking X 2 min or less To obtain chartSitting X 45-60 min Sit or stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-8# Obtain chart will accommodatePush/Pull XReaching X 12-14 inches Could be overhead, could accommodateTwisting/Turning XBending X Floor level 20-50

charts/dayObtain charts

Stoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Documenting, callingUpper Extremity X 45-60 min Documenting, callingUses Foot Controls XRepetition X 45-60 min Writing, phone callsBalancing X


COPYRIGHTED 91


Organization NameSample Description of Temporary Transitional Task: Putting Patients in Rooms (PMGMT-06)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv Date: ________ Temporary Transitional Task Supervisor: Practice Management Admin. Asst. Practice ManagerShift: __8 AM – 5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: up to 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. No history of substance abuse, knows how to do B.P., wt., and vital signs.

SENSORY EFFECT/COMMUNICATION: Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_BRIEF DESCRIPTION: Putting pts in rooms.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Practice management

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__exam_____________ Respirator - Specify Type_______________Mask___ Gown__X_ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Taking pts to exam room, ht, wt and vital signs.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min-intermittent Pt. assessmentsWalking X 5 min-intermittent Accompanying pt.Sitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3 lbs. Pt. chartPush/Pull X 20-50 times Open doorReaching X 12 in To pull chartTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 20-50 times Writing, B.P. cuff, bulbUpper Extremity X 20-50 times Writing, B.P. cuff, bulbUses Foot Controls XRepetition X 20-50 times Writing, BP cuff bulbBalancing X


COPYRIGHTED 92


Organization NameSample Description of Temporary Transitional Task: Practice Management Support(PMGMT-07)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv Date: ________ Temporary Transitional Task Supervisor: Practice Management Admin. Support Practice ManagerShift: __8 AM -5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: up to 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. No substance abuse history, basic clerical skills

SENSORY EFFECT/COMMUNICATION: Speech_X_ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_BRIEF DESCRIPTION: Assisting with clerical support



DUTIES: Update manuals, copying, data entry, compiling material.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-10 min Various activities, could accommodateWalking X 5-10 min Various activities, could accommodateSitting X 45-60 min Various activities, could accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-9# max Supplies, manual, could accommodatePush/Pull XReaching X 12” Phone, copy machine, no overhead reachingTwisting/Turning XBending X Floor level To obtain chartsStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 2 hr intermittent Dial phone, write, activity variesUpper Extremity X 2 hr intermittent Dial phone, write, activity variesUses Foot Controls XRepetition X 2 hr intermittent Dial phone, write, copying, variesBalancing X


COPYRIGHTED 93


Organization NameSample Description of Temporary Transitional Task: Verifying Appointments (PMGMT-08)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv Date: ________ Temporary Transitional Task Supervisor: Practice Management Admin. Asst. Practice ManagementShift: _8 AM-5 PM Length of Shift: 2 Max. 1 Min. Hours per Wk: 10-5 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. Phone etiquette skills, no history of substance abuse.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Verify appointments.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Practice, telephone


DUTIES: Verifying appointments.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 2-3 min To get to work areaSitting X Up to 2 hrs Sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying <1-3# SuppliesPush/Pull XReaching X 12 inches Telephone, could use headsetTwisting/Turning XBending X From floor To obtain chart, could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 2 hr, intermittent Writing, handling telephone and chartsUpper Extremity X 2 hr, intermittent Writing, handling telephone and chartsUses Foot Controls XRepetition X 2 hr, intermittent Dialing phone, writingBalancing X


COPYRIGHTED 94


Organization NameSample Description of Temporary Transitional Task: Counting Promotional Items (PR-01)

Public Relations Department

Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _____ Temporary Transitional Task Supervisor: PR Manager______Shift: _8-5_____. Length of Shift: _3 Max. 1_ Min. Hours per Wk: 3 hrs/wk



BRIEF DESCRIPTION: Counting promotional items

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PR Dept.


DUTIES: Counting out promotional items and placing in bags or box for distribution.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking XSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5# 10 ft To move supplies from one location to another- could accommodate

Push/Pull XReaching X 12” from body To obtain itemsTwisting/TurningBending XStoop/Squat XKneeling XCrawling XClimbing X 45 min intrvl. 3 hr Picking up items and placing in bag/box.Hand Movement XUpper Extremity Picking up items and placing in bag/box.Uses Foot Controls XRepetition X Picking up items and placing in bag/box.Balancing X

Organization Name


COPYRIGHTED 95


Sample Description of Temporary Transitional Task: Assisting with Distribution (PR-02)Public Relations Department

Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _____ Temporary Transitional Task Supervisor: Manager of PRShift: All shifts. Length of Shift: 1/day_ Max. _ Min. Hours per Wk:_3hr/wk_


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception__X_ Peripheral Vision__X_ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Distribution of materials

DESCRIBE WORK ENVIRONMENT:% Inside __90_ % Outside: _10__Works With Chemicals - Specify _________________Heat: _____ Cold: __X-to work outside___ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Locks, carts, own car PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Pick up materials from drop sites at either campus (Penn and Greenlawn) and drop off new material.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X To load materials and drop offWalking X 45 min intermittent To cover campusSitting X 10 min incrementsDriving X 10 min increments One campus to anotherLifting (light) 10-20 lbs.

X


X


X

Carrying XPush/Pull X 45 min intermittent Cart w/brochures and papersReaching 0 over head 12”

from bodyTo get papers out of box- could accommodate

Twisting/Turning XBending X 12” from floor To get boxes on floor-could accommodateStoop/Squat X 12” from floor To get boxed on floor-could accommodateKneeling XCrawling XClimbing XHand Movement X Pushing cart and obtain material to distributeUpper Extremity XUses Foot Controls X 10 min interval To driveRepetition X Taking materials out of box to place onto cartBalancing X


COPYRIGHTED 96


Organization NameSample Description of Temporary Transitional Task: Filing (PR-03)


Task Qualifications/Requirements/Training Category: Service/Tech./Prof. Date: _____ Temporary Transitional Task Supervisor: PR Manager_Shift: _8-5. Length of Shift: 4_ Max. 1_ Min. Hours per Wk: _12_


SENSORY EFFECT/COMMUNICATION:Speech___ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Filing photos

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PR Department, filing equipment PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Separate pile of photos and file in cabinet.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 45 min intervals up to 4 hrs.

To file-could accommodate

Walking X 10 ft. To obtain photos, as neededSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# 10 ft To obtain photosPush/Pull X Opening and closing file drawerReaching X 11” from body Obtaining photos and opening filesTwisting/Turning XBending X 12” from floor File drawerStoop/Squat X 12” from floor File drawerKneeling XCrawling XClimbing XHand Movement X 15-30 min intervals Carry, opening and filingUpper Extremity X 15-30 min intervals Carry, opening and filingUses Foot Controls XRepetition X 15-30 min FilingBalancing X


COPYRIGHTED 97


Organization NameSample Description of Temporary Transitional Task: Mailing Letters (PR-04)


Task Qualifications/Requirements/Training Category: Service/Tech./Pro f. Date: _____ Temporary Transitional Task Supervisor: PR ManagerShift: 8-5_. Length of Shift: 8 Max. 1 Min. Hours per Wk: 16


SENSORY EFFECT/COMMUNICATION:Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing __X_

BRIEF DESCRIPTION: Mailing out letters.

DESCRIBE WORK ENVIRONMENT:% Inside 100___ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PR Dept. PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Stacking letters, folding and inserting in envelope and sealing envelope.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X 10 ft. To obtain suppliesSitting X 45 min interval Sit/stand optionDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1# 10 ft. To obtain suppliesPush/Pull XReaching X 12” from body To pick up suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45 min interval Picking up, folding and sorting papersUpper Extremity X 45 min interval Picking up, folding and sorting papersUses Foot Controls XRepetition X 45 min interval Picking up, folding and sorting papersBalancing X


COPYRIGHTED 98


Organization NameSample Description of Temporary Transitional Task: Chart Review (QI-01)

Quality Improvement Department

Task Qualifications/Requirements/Training Category: _Tech./Prof. Date: ________ Temporary Transitional Task Supervisor: _Department ManagerShift: _8am – 5 pm_ Length of Shift: _8_ Max. _2__ Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: LPN minimum, RN preferred. Ability to read words and numbers.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination__ _ Hearing_ __BRIEF DESCRIPTION: Chart review

DESCRIBE WORK ENVIRONMENT:% Inside _100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: __ __ Cold: __ __ Dust: ___ Noisy: _ Humid/Water: __ _ Fumes: __ __ Odors: ____ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: May need to use copying machine. General office environment.


DUTIES: Review chart using pre-defined chart indicators and marking appropriate response. Additional comments as necessary. Tabulation of results.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X Coul.d accommodateWalking X Approx. 20 feet From Med Records to LibrarySitting X Could accommodateDriving XLifting (light) 10-20 lbs.

X May need to lift multiple charts


X


X

Carrying X Medical records to LibraryPush/Pull X Pushing cartReaching X Reaching into cart. Could accommodate.Twisting/Turning X Could accommodateBending X Could accommodateStoop/Squat X Could accommodateKneeling XCrawling XClimbing X Climb stairs but could use elevator/rampHand Movement X Writing, turning pagesUpper Extremity X Writing, turning pagesUses Foot Controls X X X Writing, turning pagesRepetition X Writing, turing pagesBalancing X Balance clipboard


COPYRIGHTED 99


Organization NameSample Description of Temporary Transitional Task: JCAHO Review (QI-02)


Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: _Department Manager_Shift: _8am – 5 pm_ Length of Shift: _8_ Max. _2__ Min. Hours per Wk:_up to 20 hours_available ongoing__ EDUCATION/EXPERIENCE: High School graduate

SENSORY EFFECT/COMMUNICATION: Speech_X__ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing_X

BRIEF DESCRIPTION: Preparation for JCAHO/AOA Reviews

DESCRIBE WORK ENVIRONMENT:% Inside _100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: __X__ Cold: __X Dust: X Noisy: X Humid/Water: X_ Fumes: __X__ Odors: ____ Gases: _____ Ventilation: _____ Machines, Tools, Equipment and Work Area: Car. General office environment.


DUTIES: Conduct mock accreditation survey using predefined questionnaire in clinical; non-clinicalAreas, including some off-site locations.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X Parking lot to interior of buildingSitting X Travel to off-site locations < 3 milesDriving X No more than 3

milesLifting (light) 10-20 lbs.

X


X


X

Carrying X < 2 pounds ClipboardPush/Pull XReaching X To open doorsTwisting/Turning X Could accommodateBending X Could accommodateStoop/Squat X Could accommodateKneeling XCrawling XClimbing X Climb stairs but could use elevator/rampHand Movement X Checking off formUpper Extremity XUses Foot Controls X Depress gas pedal; could accommodateRepetition XBalancing X Balance clipboard


COPYRIGHTED 100


Organization NameSample Description of Temporary Transitional Task: Manual Assembly/Collate (QI-03)


Task Qualifications/Requirements/Training Category: __Service Date: ________ Temporary Transitional Task Supervisor: _QI Department Manager_Shift: _8 a – 5 p Length of Shift: _8 Max. _2_ Min. Hours per Wk:_up to 15 EDUCATION/EXPERIENCE: High school graduate. Ability to understand oral and written work instructions

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination X Hearing___

BRIEF DESCRIPTION: Procedure manual assembly/collate

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: General office environment. Copier/automatic stapler.


DUTIES: Assemble manuals/copy/collate packet for distribution


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing 33%Walking 33%Sitting 33%Driving XLifting (light) 10-20 lbs.

X Lifting of manuals


X


X

Carrying X 5 pound manualsPush/Pull X Use a cart/could accommodateReaching X Could accommodateTwisting/Turning X Could accommodateBending X Could accommodateStoop/Squat X Replace paper in copierKneeling XCrawling XClimbing XHand Movement X Collating/opening bindersUpper Extremity XUses Foot Controls XRepetition XBalancing X


COPYRIGHTED 101


Organization NameSample Description of Temporary Transitional Task: Office Support (REHAB-01)

Rehabilitation Services Department

Task Qualifications/Requirements/Training Category: Service/Professional/Technical Date: ___________ Temporary Transitional Task Supervisor: Manager Rehab and Respiratory Services

Shift: _8-5_. Length of Shift: _8 Max. _1-2 Min. Hours per Wk: _40_


SENSORY EFFECT/COMMUNICATION:Speech__X_ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Completing office tasks

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Copier, fax, telephone, Penn and Greenlawn campus




Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15 min/2 x day To complete filing, could accommodateWalking X 5 min/2 x day To copy files, could accommodateSitting X 45 min Sit/stand at willDriving X Schedule, chart compilingLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying filesPush/Pull XReaching X 12 in.-no greater Filing, compiling chartsTwisting/Turning XBending X To 12” off floor Low filing-could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Compiling charts, writing, etc,,,Upper Extremity X 15 min increment Writing, file set upUses Foot Controls XRepetition X 15 min increment Writing, file set upBalancing X


COPYRIGHTED 102


Organization NameSample Description of Temporary Transitional Task: Assembling Small Equipment (RESP-01)

Respiratory Therapy Department

Task Qualifications/Requirements/Training Category: Tech. Date: ________

Temporary Transitional Task Supervisor: Respiratory SupervisorShift: 8A-5P Length of Shift: 8 Max. 4 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Knowledge of respiratory equipment beneficial technical background.


BRIEF DESCRIPTION: Assembling small respiratory equipment.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___Works With Chemicals – Specify: _________________ Heat: Cold: _____ Dust: _____ Noisy: _____ Humid/Water: XFumes: _____ Odors: X Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Respiratory utility room PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves – Specify: Exam/Utility Respirator – Specify: _______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield X Head___ Shoe___

DUTIES: Washing, drying , assembling small equipment, and stocking


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 45-60 min. Cleaning and assemblingWalking X 45-60 min/4 ft. Cleaning and assemblingSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <10# Equipment and suppliesPush/Pull X Wheels roll freely Assembling ventilatorsReaching X 12-24 inches Cleaning and assembling, dryer rack eye levelTwisting/Turning XBending X 110-120 degrees Slight/cleaning and assemblingStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Cleaning and assemblingUpper Extremity X 45-60 min Cleaning and assemblingUses Foot Controls XRepetition X 45-60 min Cleaning and assemblingBalancing X


COPYRIGHTED 103


Organization NameSample Description of Temporary Transitional Task: Office Support (RESP-02)

Respiratory Department

Task Qualifications/Requirements/Training Category: Service,Technical,Professional Date: _____ Temporary Transitional Task Supervisor: Operations Supervisor or Respiratory SupervisorShift: 7:30-4:30. Length of Shift: 8 Max. 1-2 Min. Hours per Wk: _40_


SENSORY EFFECT/COMMUNICATION:Speech_X__ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing_X__

BRIEF DESCRIPTION:Completing office tasks

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Copier, fax, telephone, Penn and Greenlawn campus




Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 15 min/2 x day To complete filing, could accommodateWalking X 5 min/ 2 x day To copy files, could accommodateSitting X 45 min Sit stand at willDriving X Schedule, chart compilingLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Carrying filesPush/Pull XReaching X 12 in.-no greater Filing, compiling chartsTwisting/Turning XBending X To 12” off floor Low filing-could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Compiling charts, writing, etc…Upper Extremity X 15 min increment Writing, file set upUses Foot Controls XRepetition X 15 min increments Writing file set upBalancing X

Organization NameSample Description of Temporary Transitional Task: Cleaning and Set Up (SLP-01)


COPYRIGHTED 104


Sleep/Wake Center Department

Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date:______Temporary Transitional Task Supervisor: Team Leader

Shift: 7A-12 M-F. Length of Shift: 5 Max. 2 Min. Hours per Wk: Up to 20__

EDUCATION/EXPERIENCE: Ability to understand simple oral and written work, instruction ...

SENSORY EFFECT/COMMUNICATION:Speech_X__ Visual Acuity__X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing_X__

BRIEF DESCRIPTION: Cleaning and setting up equipment.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify Dish soap, cleaning agents_________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Sleep Center PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Cleaning equipment, removing electrodes from patient, setting up for next study, cart restocking.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5-10 min Cleaning equipmentWalking X 30-45 min Cleaning and set up, take down, can accomm.Sitting X <5 min Can accommodateDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X <10# Equipment and suppliesPush/Pull XReaching X 12-14 inches Obtain and put away equipmentTwisting/Turning XBending X 110-120 degrees Perform take downStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Cleaning and set up equipment, 1 hand limitedUpper Extremity X 45-60 min Cleaning and set up equipment, 1 hand limitedUses Foot Controls XRepetition X 45-60 min Cleaning and set up equipment, 1 hand limitedBalancing X


COPYRIGHTED 105


Organization NameSample Description of Temporary Transitional Task: Office Support (SLP-02)

Sleep/Wake Center Department

Task Qualifications/Requirements/Training Category: Tech./Serv . Date: ________ Temporary Transitional Task Supervisor: Team LeaderShift: 7A-7P. Length of Shift: 8_ Max. 2_ Min. Hours per Wk: _up to 40_

EDUCATION/EXPERIENCE: Ability to understand simple oral and written work, instruction ...unit secretary experience helpful


BRIEF DESCRIPTION: General office tasks.

DESCRIBE WORK ENVIRONMENT:% Inside 100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:Sleep Center


DUTIES: Answering telephone, mailings, patient appointment reminder calls, filing, mail sorting, other clerical assistance.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min Perform various tasksWalking X <5 min To work area, other work stationsSitting X 45-60 min Perform various task, answer phoneDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Documents, patient chartPush/Pull X Lateral filing, to obtain chart, could

accommodateReaching X 12-14 inches Obtain suppliesTwisting/Turning XBending X 12 inch from floor Obtain chart, low, could accommodateStoop/Squat X Instead of bendingKneeling XCrawling XClimbing XHand Movement X 45-60 min Writing, answering phone, turning pageUpper Extremity X 45-60 min Writing answering phone, turning pageUses Foot Controls XRepetition 45-60 min Writing, answering phone, turning pageBalancing X

Organization Name


COPYRIGHTED 106


Sample Description of Temporary Transitional Task: Patient Follow Up Phone Calls (SLP-03)Sleep/Wake Center Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv Date: ______Temporary Transitional Task Supervisor: Team LeaderShift: _7A-10P_. Length of Shift: 8_ Max. _2 Min. Hours per Wk: Up to 40

EDUCATION/EXPERIENCE: Good phone communication skills, clinical/technical experience required.


BRIEF DESCRIPTION: Making follow up phone calls to patients.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Sleep center


DUTIES: Contacting patients following sleep studies to confirm results that were received and use/effective therapy.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min To obtain suppliesWalking X <5 min To work area and obtain suppliesSitting X 45-60 min Sit or stand options could accommodate

wheelchairDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Binders, suppliesPush/Pull XReaching X 12 inch Binder and supplies, headset availableTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Writing, dialing, paperworkUpper Extremity X 45-60 min Writing, dialing, paperworkUses Foot Controls XRepetition X 45-60 min Writing, dialing, paperworkBalancing X

Organization NameSample Description of Temporary Transitional Task: Quality Assurance Data Collection and Review (SLP-04

Sleep/Wake Center Department Supervisor Signature: _______________________________________ Date: _____________________

COPYRIGHTED 107


Task Qualifications/Requirements/Training Category: Prof./Serv./Tech. Date: ________Temporary Transitional Task Supervisor: Team LeaderShift: _24 hrs. S-F. Length of Shift: _ 8 Max. _2 Min. Hours per Wk: Up to 40 hours__

EDUCATION/EXPERIENCE: Clinical/Technical experience required.


BRIEF DESCRIPTION: Collection and review of quality assurance data.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___Works With Chemicals - Specify _________________Heat: _____ Cold: _____ Dust: _____ Noisy: _____ Humid/Water: ______ Fumes: _____ Odors: _____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Sleep center PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Quality assurance sleep studies, routing slips, filing, chart check off.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X <5 min To obtain suppliesWalking X <5 min To work area, obtain suppliesSitting X 45-60 min Sit and stand option can accommodate

wheelchairDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Binders, supplies, chartsPush/Pull XReaching X 12 inch Binder and suppliesTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 45-60 min Writing, paperworkUpper Extremity X 45-60 min Writing, paperworkUses Foot Controls XRepetition X 45-60 min Writing, paperworkBalancing X

Organization NameSample Description of Temporary Transitional Task: Linen Packets (SUR-01)

Surgery Department


COPYRIGHTED 108


Task Qualifications/Requirements/Training Category: Service Date: ________ Temporary Transitional Task Supervisor: Charge NurseShift: Any Length of Shift: __ Max. ___ Min. Hours per Wk:_16 EDUCATION/EXPERIENCE:

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing X_

BRIEF DESCRIPTION:

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: X Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Making linen packets by folding and placing on cart/rack.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing XWalking X < 50 feetSitting xDriving xLifting (light) 10-20 lbs.

X


X


X

Carrying x < 10 pounds Carrying linenPush/Pull X Could accommodate. Use of small linen cartReaching XTwisting/Turning X To pack cartBending XStoop/Squat XKneeling xCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls xRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Manual Update (SUR-02)

Surgery Department

Task Qualifications/Requirements/Training Category: _Service Date: ________DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify __none________


COPYRIGHTED 109


Temporary Transitional Task Supervisor: _Charge Nurse or Educator______Shift: 3 – 11 pm Length of Shift: _8_ Max. _2__ Min. Hours per k: 10 EDUCATION/EXPERIENCE: Ability to understand oral and written work instructions, alphabetize, put numbers in a row, good organizational skills


BRIEF DESCRIPTION: Updating manuals

Heat: _____ Cold: _____ Dust: __x__ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: General office


DUTIES: Reviewing and updating department and hospital manuals.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X < 50 feetSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 10 pounds ManualsPush/PullxReaching X Across deskTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: OR Packets (SUR-03)

Surgery Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify none


COPYRIGHTED 110


Temporary Transitional Task Supervisor: Charge NurseShift: AM/PM Length of Shift: __ Max. ___ Min. Hours per Wk: 10 EDUCATION/EXPERIENCE:

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception X Peripheral Vision___ Color Discrimination X Hearing X

BRIEF DESCRIPTION:

Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Office environment


DUTIES: Putting OR packets together consisting of pre-developed forms/questionnaires

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing x Could accommodate by sittingWalking X < 50 feetSitting X Could accommodate by standingDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 2 pound packetsPush/Pull XReaching XTwisting/Turning XBending x Lift packets on lower shelf but could

accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Answer Phone (SUR-04)

Surgery Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________ DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ___none_______


COPYRIGHTED 111


Temporary Transitional Task Supervisor: Contact nurse in PACUShift: 10p - 6:30 a Length of Shift: 8 Max. 2 Min. Hours per Wk. 40 EDUCATION/EXPERIENCE: General ability to answer phone. Medical background/Terminology needed.


BRIEF DESCRIPTION:

Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: X Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Phone - PACU

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_Surgical Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Answer the phone in PACU


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X < 50 feet Might need to ask questions of staffSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 10 pounds Ability to carry small objectsPush/Pull XReaching XTwisting/Turning X Can accommodateBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity X Answering phoneUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Preference Charts (SUR-05)

Surgery Department

Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____


COPYRIGHTED 112


Temporary Transitional Task Supervisor: _Dept. Manager/Charge Nurse/SecretaryShift: days Length of Shift: 8 Max. 4 Min. Hours per Wk: 30 EDUCATION/EXPERIENCE: Licensed RN, Surgical. Needs to be versatile with recent OR experience.

SENSORY EFFECT/COMMUNICATION: Speech X Visual Acuity X Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing XBRIEF DESCRIPTION: Updating preference charts.

Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: General Office


DUTIES: Updating and correcting preference charts through team leaders.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing XWalking X < 50 feetSitting XDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X < 2 pounds PaperPush/Pull XReaching XTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Patient Comfort (SUR-06)

Surgery Department

Task Qualifications/Requirements/Training Category: Serv./Tech./Prof. Date: ______ Temporary Transitional Task Supervisor: Charge NurseShift: 10 a – 6:30 p or 7a – 3:30 p Length of Shift: 8 Max. 4 Min.

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify __None_________ Heat: _____ Cold: _____ Dust: _____ Noisy: X Humid/Water: X Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


COPYRIGHTED 113


Hours per Wk: 40 EDUCATION/EXPERIENCE: Medical background preferred.


BRIEF DESCRIPTION: Patient comfort in PACU or Pre-Op holding

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type_______________ Respirator - Specify Type_______________Mask X Gown X Scrubs X Glasses/Goggles/Face Shield X Head___ Shoe___

DUTIES: Obtaining ice/water, warm blankets, transporting patients on bed


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing XWalking X Approx. 30 feet

maximumSitting XDriving XLifting (light) 10-20 lbs.

X Passing ice, blankets, water


X Moving patients


X Moving patients

Carrying XPush/Pull XReaching X Obtaining iceTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement XUpper Extremity XUses Foot Controls XRepetition XBalancing x

Organization NameSample Description of Temporary Transitional Task: Chart Review (VNS-01)

Visiting Nursing Services Department

Task Qualifications/Requirements/Training Category: Prof./Tech Date: ________ Temporary Transitional Task Supervisor:: UR CoordinatorShift: 8 AM -5_PM Length of Shift: 8 Max. 4 Min. Hours per Wk:: 40

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: VNS office


COPYRIGHTED 114


EDUCATION/EXPERIENCE: RN

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity_X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Review pt. charts


DUTIES: Review charts for content and appropriate clinical documentation.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 5 min/hr To obtain suppliesWalking X 5 min/hr To get to work areaSitting X 1 hr at a time Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# For supplies could accommodatePush/Pull X 6 x hr To obtain charts, could accommodateReaching X 6 x 1hr, 12-15” To obtain charts/supplies, could accommodateTwisting/Turning XBending X 6 x/hr To obtain charts/supplies, could accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Intermittent To turn pages, write, obtain suppliesUpper Extremity X Intermittent Turn pages, write, obtain suppliesUses Foot Controls XRepetition X Iintermittent WritingBalancing X

Organization NameSample Description of Temporary Transitional Task: Diabetes Follow Up Calls (VNS-02)


Task Qualifications/Requirements/Training Category: Professional Date: ________ Temporary Transitional Task Supervisor: Homecare Manager

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: VNS Office


COPYRIGHTED 115


Shift: _8 AM –5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: LPN, RN, Dietician

SENSORY EFFECT/COMMUNICATION: Speech _X_ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing _X_

BRIEF DESCRIPTION: Calling patients to assess current diabetes status. Calling physicians and community resources for follow up.


DUTIES: See “brief description” chart review.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min/hr To obtain suppliesWalking X 5 min/hr To get to work areaSitting X 1 hr at a time Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# For supplies, chart, could accommodatePush/Pull X Up to 10/hr To obtain charts, could accommodateReaching X Up to 10/hr Obtain phone, supplies, could accommodateTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Intermittent WritingUpper Extremity X Intermittent WritingUses Foot Controls XRepetition X Intermittent WritingBalancing X

Organization NameSample Description of Temporary Transitional Task: Education Support (VNS-03)


Task Qualifications/Requirements/Training Category: Prof./Tech./Serv. Date: ________ Temporary Transitional Task Supervisor: Clinical Education Coordinator

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____


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Shift: 8 AM - 5 PM Length of Shift: _8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity _X_ Depth Perception___ Peripheral Vision___ Color Discrimination _X_ Hearing _X_BRIEF DESCRIPTION: Review education materials, create ed. Materials, put ed. Materials in packets or bins, copy

Machines, Tools, Equipment and Work Area: VNS office: Copy machine, keyboard, printer, TV and VCR, tape recorder


DUTIES: Read ed. Materials and evaluate view/listen to ed. Materials and evaluate, copy, type info in computer, print, create ed. Materials for pts/staff, compile packets of info.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-60 min/hr Obtain suppliesWalking X 5-30 min/hr Get to areaSitting X 5-60 min/hr Perform tasksDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Can accommodate, suppliesPush/Pull X 5-10 x day Fill printer paper etc…Reaching X 12-15” None above shoulderTwisting/Turning XBending X 10-20 x day Gather supplies and distributeStoop/Squat X 10-20 x day Copies to mailboxes/binsKneeling XCrawling XClimbing XHand Movement X 5-60 min/hr Handle supplies, perform tasksUpper Extremity X 5-60 min/hr Handle supplies, perform tasksUses Foot Controls XRepetition X 5-60 min/hr Handle supplies, perform tasksBalancing X

Organization NameSample Description of Temporary Transitional Task: Errands (VNS-04)


Task Qualifications/Requirements/Training Category: Prof/Tech/Serv Date: ________ Temporary Transitional Task Supervisor: VNS Manager

DESCRIBE WORK ENVIRONMENT:% Inside _50__ % Outside: 50 Works With Chemicals - Specify ______________ Heat: _seasonal____ Cold: _seasonal____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____


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Shift: 8 AM - 5 PM Length of Shift: 8_Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction, Needs a driver’s license.

SENSORY EFFECT/COMMUNICATION: Speech___ Visual Acuity__X_ Depth Perception_X__ Peripheral Vision_X__ Color Discrimination___ Hearing__X_BRIEF DESCRIPTION: Running errands

Machines, Tools, Equipment and Work Area: VNS office and community

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:SeatbeltGloves - Specify Type_______________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Run variety of errands depending on limitations.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-30 min Running errands, could accommodateWalking X 5-30 min Running errands, could accommodateSitting X 5-30 min Running errands, could accommodateDriving X 5-60 min Running errands, could accommodateLifting (light) 10-20 lbs.

X 1 x 2hrs Equipment, supplies, could accommodate


X


X

Carrying X 1-10# Equipment, suppliesPush/Pull X Up to 20# Supplies in and out of vehicleReaching X 15 inch Supplies in and out of vehicleTwisting/Turning XBending XStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Intermittent Handling supplies and drivingUpper Extremity X Intermittent Handling supplies and drivingUses Foot Controls X 5-60 min To driveRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Filing (VNS-05)


Task Qualifications/Requirements/Training Category: Serv/Tech/Prof Date: ________ Temporary Transitional Task Supervisor: Support Services Manager

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____


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Shift: 8 AM -5 PM M-F Length of Shift: _8 Max. 4 Min. Hours per Wk: 40 EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instructions. Cannot be VNS employee.


BRIEF DESCRIPTION: Same as office support VNS

Machines, Tools, Equipment and Work Area:


DUTIES: Filing of confidential materials.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-60 min/hr Could accommodateWalking X 5-10 min/hr To get to work area.Sitting X 5-30 min/hr Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Could accommodatePush/Pull X 0-10 x hr To obtain suppliesReaching X 12-15”, 0-10 x hr To obtain suppliesTwisting/Turning XBending X 0-10 x hr To obtain suppliesStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Constant Completing a variety of tasksUpper Extremity X Constant Completing a variety of tasksUses Foot Controls XRepetition X Intermittent Completing a variety of tasksBalancing X

Organization NameSample Description of Temporary Transitional Task: Flu Shot Support (VNS-06)


Task Qualifications/Requirements/Training Category: Serv/Tech/Prof Date: ________ Temporary Transitional Task Supervisor: VNS ManagerShift: poss 5A-10P any 7 days per week Length of Shift: 6 Max. 3 Min. Hours per Wk: 40+

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Variety of clinic sites.


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EDUCATION/EXPERIENCE: Ability to understand simple oral work, instruction… Able to record clerical information, count money, organizational skills.

SENSORY EFFECT/COMMUNICATION: Speech__X_ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_BRIEF DESCRIPTION: Seasonal need- Sept.-Nov. only


DUTIES: Delivery of promotional items, cash receipts, clerical.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 0-5 min intermittent

Gathering items, could accommodate

Walking X 5-10 min To/from siteSitting X 1-6 hrs could be

intermittentAt table at clinic

Driving X 2-50 miles To clinic and to deliver itemsLifting (light) 10-20 lbs.

X Beginning/end of clinic

Supplies-could accommodate


X


X

Carrying X 1-3# Office suppliesPush/Pull XReaching X 12 inches For suppliesTwisting/Turning XBending X intermittent Over table, could sitStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Up to 1 hr Writing, cash collectionUpper Extremity X Up to 1 hr Writing, cash collectionUses Foot Controls XRepetition X Up to 1 hr Hand movementsBalancing X

Organization NameSample Description of Temporary Transitional Task: Administering Flu Shots (VNS-07 )


Task Qualifications/Requirements/Training Category: Prof./Tech Date: ________ Temporary Transitional Task Supervisor: Clinical SupervisorShift: poss 5AM-10PM 7 days per wk Length of Shift: 6 Max. 3 Min.

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: Variety of clinic sites


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Hours per Wk: 40+ EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. RN,LPN

SENSORY EFFECT/COMMUNICATION: Speech__X_ Visual Acuity___ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing___BRIEF DESCRIPTION: Administering flu injections, seasonal need Sept.-Nov only

PERSONAL PROTECTIVE EQUIPMENT REQUIRED:Gloves - Specify Type__exam_____________ Respirator - Specify Type_______________Mask___ Gown___ Scrubs___ Glasses/Goggles/Face Shield___ Head___ Shoe___

DUTIES: Administering flu injections


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 1-5 hr Administering injections, could accommodateWalking X 5-10 min To/from clinic areaSitting X 3-6 hrs Between injections or during-nurse preferDriving X 2-50 miles To/from clinicLifting (light) 10-20 lbs.

X To and from clinic Beginning/end of clinic supplies could accommodate


X


X

Carrying X 1-3# Clinical suppliesPush/Pull XReaching X 12 inches repetitive For clinical suppliesTwisting/Turning XBending X Intermittent Depending on method of giving shots-could

accommodateStoop/Squat XKneeling XCrawling XClimbing XHand Movement X 1-6 hrs Giving injectionsUpper Extremity X 1-6 hrs Giving injectionsUses Foot Controls XRepetition X 1-6 hrs Hand movement for injectionBalancing X

Organization NameSample Description of Temporary Transitional Task:_Professional Information Data Entry (VNS-08)


Task Qualifications/Requirements/Training Category: Tech/Prof Date: ________ Temporary Transitional Task Supervisor: Nursing Services SupervisorShift: _8 AM –5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk: 40

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: VNS office computer and printer


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EDUCATION/EXPERIENCE: RN, LPN.


BRIEF DESCRIPTION: Entering clinical data.


DUTIES: Entering clinical data and printing information.

Activity Never Rare

0-25%Occasional


Constant76-100%



Standing X 5 min, 10-20 times At printer, could accommodateWalking X 5 min, 10-20 times To work area, could accommodateSitting X 45 min-1 hr Could sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X



Twisting/Turning XBending X 12” from floor Filing paper in printer, could accommodateStoop/Squat X 12” from floor Filing paper in printer, could accommodateKneeling XCrawling XClimbing XHand Movement X Intermittent KeyboardingUpper Extremity X Intermittent KeyboardingUses Foot Controls XRepetition X Intermittent KeyboardingBalancing X

Organization NameSample Description of Temporary Transitional Task: General Data Entry (VNS-09)


Task Qualifications/Requirements/Training Category: Tech/Service/Prof Date: ________ Temporary Transitional Task Supervisor: Support Service

Shift: 8 AM-5 PM M-F Length of Shift: 8 Max. 4 Min. Hours per Wk: 40

DESCRIBE WORK ENVIRONMENT:% Inside 100 % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: VNS office computer and printer.


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EDUCATION/EXPERIENCE: Ability to understand simple oral and written work, instruction. Keyboarding experience, medical terminology.


BRIEF DESCRIPTION: Entering general information in computer.


DUTIES: Entering general information into computer and printing information.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5 min, 10-20 times At printer, could accommodateWalking X 5 min, 10-20 times To work area, could accommodateSitting X 45 min-1 hr Could sot and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X



Twisting/Turning XBending X 12” from floor Filing paper in printer, could accommodateStoop/Squat X 12” from floor Filing paper in printer, could accommodateKneeling XCrawling XClimbing XHand Movement X Intermittent KeyboardingUpper Extremity X Intermittent KeyboardingUses Foot Controls XRepetition X Intermittent KeyboardingBalancing X

Organization NameSample Description of Temporary Transitional Task: Joint Visit (VNS-10)


Task Qualifications/Requirements/Training Category: Professional Date: ________ Temporary Transitional Task Supervisor: Nursing Service Supervisor

DESCRIBE WORK ENVIRONMENT:% Inside _75__ % Outside: _25__ Works With Chemicals - Specify ______________ Heat: X Cold: X Dust: X Noisy: X Humid/Water: X Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area:


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Shift: __8 AM – 5 PM Length of Shift: 4 Max. 4 Min. Hours per Wk: 20 EDUCATION/EXPERIENCE: RN, 2 yr. nursing, 1 yr. home care, PT, OT

SENSORY EFFECT/COMMUNICATION: Speech__X_ Visual Acuity_X__ Depth Perception___ Peripheral Vision___ Color Discrimination___ Hearing__X_

BRIEF DESCRIPTION: Making joint home visits with Home Health Aides, PTA’s, COTA’s.


DUTIES: Writing notes on visits (check list)


Occasional26-50%

Frequent51-75%

Constant76-100%



Standing X 5-60 min While observationWalking X 5-10 min x 4 To home from carSitting X 5-60 min While observingDriving X 5-45 min To and from office/patient homeLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-5#, 1-5 x day SuppliesPush/Pull X 1-4 x day Car door, house doorsReaching X 1-5 x day SuppliesTwisting/Turning X 1-4 x day Getting in/out carBending X 1-4 x day Getting in/out carStoop/Squat X 1-4 x day SuppliesKneeling XCrawling XClimbing X 1-8 x varies Stairs to patients homeHand Movement X 1-8 x day Driving carUpper ExtremityUses Foot Controls X 1-8 x Driving carRepetition XBalancing X

Organization NameSample Description of Temporary Transitional Task: Office Support (VNS-11)


Task Qualifications/Requirements/Training Category: Serv./Tech./Prof Date: ________ Temporary Transitional Task Supervisor: Support Services Manager

Shift: _8 AM -5 PM Length of Shift: 8 Max. 4 Min. Hours per Wk: 40

DESCRIBE WORK ENVIRONMENT:% Inside _100__ % Outside: ___ Works With Chemicals - Specify ______________ Heat: _____ Cold: _____ Dust: _____ Noisy: ___ Humid/Water: ____ Fumes: _____ Odors: ____ Gases: _____ Ventilation: _____Machines, Tools, Equipment and Work Area: VNS office


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EDUCATION/EXPERIENCE: Ability to understand simple oral and written work instruction. Organizational skills, knowledge of office machine, copier, and printer.


BRIEF DESCRIPTION: Alphabetize progress notes, mailings, copying, fill printers and copiers with paper, data entry.


DUTIES: Copying, mailings, alphabetize progress notes, fill printers and copiers and staplers, data entry, compile packets.


Occasional26-50%

Frequent51-75%

Constant76-100%



Standin/g X 5-60 min/hr Could accommodateWalking X 5-10 min/hr To get to work areaSitting X 5-60 min/hr Sit and stand at willDriving XLifting (light) 10-20 lbs.

X


X


X

Carrying X 1-3# Could accommodatePush/Pull X 0-10 x/hr To obtain suppliesReaching X 12-15”, 0-10 x hr To obtain suppliesTwisting/Turning XBending X 0-10 x/hr To obtain suppliesStoop/Squat XKneeling XCrawling XClimbing XHand Movement X Constant Completing a variety of tasksUpper Extremity X Constant Completing a variety of tasksUses Foot Controls XRepetition X Intermittent Completing a variety of tasksBalancing X

This document contains representative examples only to provide you with guidance. Please consult with your risk control consultant/professional with respect to the use or development of your own safety management tools.


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Revised 01/13